Healthcare Provider Details

I. General information

NPI: 1275347395
Provider Name (Legal Business Name): RADIANT HEART THERAPY PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

514 COUNTY ROAD 2730
DECATUR TX
76234-7518
US

V. Phone/Fax

Practice location:
  • Phone: 818-618-3619
  • Fax:
Mailing address:
  • Phone: 818-618-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SAHARA ELIZABETH BUNNA
Title or Position: LPC/CEO/OWNER
Credential: MA, MFT, LPC, NCC
Phone: 818-618-3619