Healthcare Provider Details

I. General information

NPI: 1649135245
Provider Name (Legal Business Name): PORCH LIGHT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 DAHLONEGA ST STE A601
CUMMING GA
30040-2488
US

IV. Provider business mailing address

327 DAHLONEGA ST STE A601
CUMMING GA
30040-2488
US

V. Phone/Fax

Practice location:
  • Phone: 470-253-1090
  • Fax:
Mailing address:
  • Phone: 470-253-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: GRACYN PAIGE WISTOSKI JENNINGS
Title or Position: OWNER
Credential: M.ED., LPC
Phone: 470-253-1090