Healthcare Provider Details

I. General information

NPI: 1396938262
Provider Name (Legal Business Name): NEW LIGHT CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8511 STATE RD
MILLINGTON MI
48746-9446
US

IV. Provider business mailing address

PO BOX 359 8511 STATE ST.
MILLINGTON MI
48746-0359
US

V. Phone/Fax

Practice location:
  • Phone: 989-871-6695
  • Fax: 989-871-3663
Mailing address:
  • Phone: 989-871-6695
  • Fax: 989-871-3663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number790026
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number790026
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number790026
License Number StateMI

VIII. Authorized Official

Name: MR. RICHARD O WATKINS JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW LMSW
Phone: 989-871-6695