Healthcare Provider Details

I. General information

NPI: 1023829819
Provider Name (Legal Business Name): BEACONLIGHT COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CARRIAGE WAY STE 200
HURRICANE WV
25526-1530
US

IV. Provider business mailing address

101 CARRIAGE WAY STE 200
HURRICANE WV
25526-1530
US

V. Phone/Fax

Practice location:
  • Phone: 304-305-1309
  • Fax:
Mailing address:
  • Phone: 304-444-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON PAUL WAGGONER
Title or Position: OWNER
Credential: PHD
Phone: 304-444-7315