Provider Demographics
NPI:1427159078
Name:BRITE SMILZ FAMILY & COMMUNITY CONNECTIONS LLC
Entity type:Organization
Organization Name:BRITE SMILZ FAMILY & COMMUNITY CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:252-537-7575
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:1165 GREGORY DR
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870
Mailing Address - Country:US
Mailing Address - Phone:252-537-7575
Mailing Address - Fax:252-537-9008
Practice Address - Street 1:1165 GREGORY DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-7575
Practice Address - Fax:252-537-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X, 101YA0400X, 103T00000X, 1041C0700X, 106H00000X, 171M00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Not Answered171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018G5OtherBLUECROSS BLUESHIELD
NC6005333Medicaid
NC8301698QMedicaid
NC8300814BMedicaid
NC8300814GMedicaid
NC8301698PMedicaid
NC8300599BMedicaid
NC3408200Medicaid
NC8300599GMedicaid