Healthcare Provider Details

I. General information

NPI: 1801727664
Provider Name (Legal Business Name): EMERALD LIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 KEMPER MEADOW DR STE 12
CINCINNATI OH
45240-1650
US

IV. Provider business mailing address

3253 INDIAN RIPPLE RD
DAYTON OH
45440-3632
US

V. Phone/Fax

Practice location:
  • Phone: 513-294-8330
  • Fax:
Mailing address:
  • Phone: 937-654-3986
  • 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:
Title or Position:
Credential:
Phone: