Provider Demographics
NPI:1356651582
Name:BRIGHTPATH BEHAVIORAL HEALTH GROUP, L.L.C.
Entity type:Organization
Organization Name:BRIGHTPATH BEHAVIORAL HEALTH GROUP, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENSIA
Authorized Official - Middle Name:DEMARIO
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-871-9946
Mailing Address - Street 1:395 CENTRAL PARK PL NE
Mailing Address - Street 2:STE 530
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1253
Mailing Address - Country:US
Mailing Address - Phone:770-871-9946
Mailing Address - Fax:
Practice Address - Street 1:2969 E PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2215
Practice Address - Country:US
Practice Address - Phone:770-871-9946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)