Healthcare Provider Details

I. General information

NPI: 1871361915
Provider Name (Legal Business Name): SONS AND DAUGHTERS OF LIGHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 FOLLY ROAD BLVD STE B9 1177
CHARLESTON SC
29407-7551
US

IV. Provider business mailing address

78 FOLLY ROAD BLVD STE B91177
CHARLESTON SC
29407-7551
US

V. Phone/Fax

Practice location:
  • Phone: 854-832-3603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRIAN LENEAU
Title or Position: OWNER
Credential: MS LPC
Phone: 706-840-6302