Provider Demographics
NPI:1447721055
Name:ALEXIS BRIGHTMAN, PLLC
Entity type:Organization
Organization Name:ALEXIS BRIGHTMAN, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPA
Authorized Official - Phone:704-807-2102
Mailing Address - Street 1:1914 J N PEASE PL STE 172
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4504
Mailing Address - Country:US
Mailing Address - Phone:704-807-2102
Mailing Address - Fax:
Practice Address - Street 1:1914 J N PEASE PL STE 172
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4504
Practice Address - Country:US
Practice Address - Phone:980-553-1242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008882Medicaid