Healthcare Provider Details

I. General information

NPI: 1528703949
Provider Name (Legal Business Name): RADIANT CHRISTIAN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N LAKEWOOD DR STE 222
COEUR D ALENE ID
83814-2473
US

IV. Provider business mailing address

2101 N LAKEWOOD DR STE 222
COEUR D ALENE ID
83814-2473
US

V. Phone/Fax

Practice location:
  • Phone: 208-274-3320
  • Fax:
Mailing address:
  • Phone: 208-274-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ADAM ROBICHAUD
Title or Position: OWNER
Credential:
Phone: 208-274-3320