Provider Demographics
NPI:1982948774
Name:BRIGHT FUTURES OF VIRGINIA, LLC
Entity Type:Organization
Organization Name:BRIGHT FUTURES OF VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:804-874-6177
Mailing Address - Street 1:1483B ANDERSON HWY
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23040
Mailing Address - Country:US
Mailing Address - Phone:804-492-4322
Mailing Address - Fax:
Practice Address - Street 1:1483 B ANDERSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:VA
Practice Address - Zip Code:23040
Practice Address - Country:US
Practice Address - Phone:804-492-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1970-03-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1970Medicaid