Provider Demographics
NPI:1760070924
Name:A BRIGHTER CONNECTION
Entity Type:Organization
Organization Name:A BRIGHTER CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOOTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSW,CWCM
Authorized Official - Phone:850-895-9452
Mailing Address - Street 1:8021 PIN OAK RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-0721
Mailing Address - Country:US
Mailing Address - Phone:850-895-9452
Mailing Address - Fax:
Practice Address - Street 1:1290 CEDAR CENTER DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-4876
Practice Address - Country:US
Practice Address - Phone:850-895-9452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health