Provider Demographics
NPI:1619304722
Name:BRIGHT STAR COUNSELING LLC
Entity Type:Organization
Organization Name:BRIGHT STAR COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-379-9967
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:SUNNY SIDE
Mailing Address - State:GA
Mailing Address - Zip Code:30284-0566
Mailing Address - Country:US
Mailing Address - Phone:678-379-9967
Mailing Address - Fax:
Practice Address - Street 1:37 WOOLSEY RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2922
Practice Address - Country:US
Practice Address - Phone:678-379-9967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 02661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA721587Medicaid