Provider Demographics
NPI:1487414264
Name:BRIGHTSIDE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:BRIGHTSIDE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAVENDA
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,MA
Authorized Official - Phone:910-236-2050
Mailing Address - Street 1:142 REHOBETH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-8014
Mailing Address - Country:US
Mailing Address - Phone:910-236-2050
Mailing Address - Fax:910-516-1333
Practice Address - Street 1:142 REHOBETH CHURCH RD
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-8014
Practice Address - Country:US
Practice Address - Phone:910-236-2050
Practice Address - Fax:910-516-1333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESH START COUNSELING SERVICES,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty