Healthcare Provider Details

I. General information

NPI: 1982302261
Provider Name (Legal Business Name): CANDLELIGHT COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 S ASHLEY ST STE 102
ANN ARBOR MI
48104-1351
US

IV. Provider business mailing address

6 PARKVIEW PL APT 3
ANN ARBOR MI
48103-3368
US

V. Phone/Fax

Practice location:
  • Phone: 810-295-1738
  • Fax:
Mailing address:
  • Phone: 810-295-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER SANDERSON
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW
Phone: 810-295-1738