Healthcare Provider Details

I. General information

NPI: 1639799661
Provider Name (Legal Business Name): BRIGHT LIGHT COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2020
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W 4TH AVE
RED SPRINGS NC
28377-1508
US

IV. Provider business mailing address

112 W 4TH AVE
RED SPRINGS NC
28377-1508
US

V. Phone/Fax

Practice location:
  • Phone: 910-802-2008
  • Fax:
Mailing address:
  • Phone: 910-802-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE L CARTHEN
Title or Position: CLINICAL DIRECTOR
Credential: LCMHCS
Phone: 910-733-2155