Healthcare Provider Details

I. General information

NPI: 1831028810
Provider Name (Legal Business Name): BEACON LIGHT COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 BISHOPS RIDGE PKWY # 28606
BLOWING ROCK NC
28605-9641
US

IV. Provider business mailing address

5059 DOWNING DR
FORT MILL SC
29708-6518
US

V. Phone/Fax

Practice location:
  • Phone: 704-389-0508
  • Fax:
Mailing address:
  • Phone: 617-529-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANDREW SYDNEY
Title or Position: OWNER
Credential: LCMHC
Phone: 617-529-7475