Provider Demographics
NPI:1023861408
Name:WEATHERINGTON, BRIGETTA CHARMAINE
Entity type:Individual
Prefix:
First Name:BRIGETTA
Middle Name:CHARMAINE
Last Name:WEATHERINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 JASONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7297
Mailing Address - Country:US
Mailing Address - Phone:301-704-5773
Mailing Address - Fax:
Practice Address - Street 1:14405 JASONWOOD CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7297
Practice Address - Country:US
Practice Address - Phone:301-704-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM1030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist