Healthcare Provider Details

I. General information

NPI: 1114737434
Provider Name (Legal Business Name): LIGHT WITHIN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 QUAZAR RD
TALLAHASSEE FL
32311-4110
US

IV. Provider business mailing address

1609 QUAZAR RD
TALLAHASSEE FL
32311-4110
US

V. Phone/Fax

Practice location:
  • Phone: 850-270-7188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARY LYN NORMAN SONNTAG
Title or Position: OWNER/ THERAPIST
Credential: LMFT, NCC
Phone: 850-270-7188