MEDICARE: LIGHT OF LIFE COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245187624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHT OF LIFE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	508 HUNT FOREST CT
Second Line	:
City	:	PLEASANT GARDEN
State	:	NC
Zip	:	27313-9748
Country	:	US
Telephone Number	:	336-209-3439
Fax Number	:	336-209-3439

Provider Business Practice Location Address
First Line	:	1451 S ELM EUGENE ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-2200
Country	:	US
Telephone Number	:	336-209-3439
Fax Number	:

Authorized Official
Title or Position	:	LIC CLINICAL MENT HEALTH COUNSELOR
Name	:	MEGAN D JORDAN
Credential	:	LCMHCS
Telephone Number	:	336-209-3439

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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