Basic Information
| Provider Information | |||||||||
| NPI: | 1396322665 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAURA BRIGHTON, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 913 FIRST COLONIAL RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234543198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576227017 | ||||||||
| FaxNumber: | 7576408402 | ||||||||
| Practice Location | |||||||||
| Address1: | 913 FIRST COLONIAL RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234543198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576227017 | ||||||||
| FaxNumber: | 7576408402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2021 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 7579072567 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 0904002453 | 01 | VA | LICENSE | OTHER |