Healthcare Provider Details

I. General information

NPI: 1497676852
Provider Name (Legal Business Name): LIGHT UPON LIGHT COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 CARRICKFERGUS COURT
DURHAM NC
27713
US

IV. Provider business mailing address

1204 FAYETTEVILLE ST # 1094
DURHAM NC
27707-2324
US

V. Phone/Fax

Practice location:
  • Phone: 919-373-5455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. AZLEENA SALLEH AZHAR
Title or Position: OUTPATIENT PSYCHOTHERAPIST
Credential: LCSW C019422
Phone: 919-373-5455