Organization
BRIGHT PATH LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN MOORE (CHIEF EXECUTIVE OFFICER)
(804) 605-6320
Entity
Organization
Contact information
Practice address
4729 ALTAIR RD, HENRICO, VA 23231-2523
(804) 605-6320
Mailing address
4729 ALTAIR RD, HENRICO, VA 23231-2523
(804) 605-6320
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
225100000X
Physical Therapist
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/26/2025
Last updated
07/07/2025
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