Provider Demographics
NPI:1447705082
Name:BRIGHTMAN, ALEXIS (LPA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BRIGHTMAN
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 BONITA LN APT 616
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1082
Mailing Address - Country:US
Mailing Address - Phone:704-807-2102
Mailing Address - Fax:
Practice Address - Street 1:5108 REAGAN DR
Practice Address - Street 2:SUITE 14
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-3103
Practice Address - Country:US
Practice Address - Phone:980-498-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5029103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist