Healthcare Provider Details

I. General information

NPI: 1194532887
Provider Name (Legal Business Name): GUIDELIGHT HEALTH OF NORTH CAROLINA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 PIEDMONT ROW DR S STE 407
CHARLOTTE NC
28287-3884
US

IV. Provider business mailing address

6060 PIEDMONT ROW DR S STE 407
CHARLOTTE NC
28287-3884
US

V. Phone/Fax

Practice location:
  • Phone: 704-228-1774
  • Fax: 704-270-8297
Mailing address:
  • Phone: 704-228-1774
  • Fax: 704-270-8297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES SPOSATO
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 617-249-3557