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General NPI Number Information
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NPI Number | 1073312104
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Entity Type | Organization
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Legal Business Name | RADIANT LIFE COUNSELING CENTER PLLC
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Dates
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Enumeration Date | 03/11/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 219 DICK ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-5727
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Country | US
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Telephone | 910-691-4864
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 H BULLARD RD
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City | HOPE MILLS
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State | NC
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Zip | 28348-7932
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Country | US
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Telephone | 910-691-4864
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Fax |
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Authorized Official
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Title or Position | MEMBER/ORGANIZER
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Name | BRITANIA HAVER
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Credential | LCMHC-A, LCAS-A
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Telephone | 910-691-4864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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