Healthcare Provider Details

I. General information

NPI: 1699482919
Provider Name (Legal Business Name): LIGHT COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8130 OSWEGO RD STE 1
LIVERPOOL NY
13090-1520
US

IV. Provider business mailing address

20564 TIMBERLAKE RD STE B
LYNCHBURG VA
24502-7246
US

V. Phone/Fax

Practice location:
  • Phone: 434-384-1594
  • Fax: 434-384-3228
Mailing address:
  • Phone: 434-384-1594
  • Fax: 434-384-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA HARTLE
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 434-219-5192