Provider Demographics
NPI:1568955144
Name:BRIGHT LIGHT BEHAVIORAL AND DEVELOPMENTAL SERVICES
Entity Type:Organization
Organization Name:BRIGHT LIGHT BEHAVIORAL AND DEVELOPMENTAL SERVICES
Other - Org Name:BRIGHT LIGHT BEHAVIORAL AND DEVELOPMENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:912-677-4292
Mailing Address - Street 1:31 PINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6807
Mailing Address - Country:US
Mailing Address - Phone:912-677-4292
Mailing Address - Fax:
Practice Address - Street 1:3229 ARGENT BLVD STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-3114
Practice Address - Country:US
Practice Address - Phone:912-677-4292
Practice Address - Fax:912-200-5712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty