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General NPI Number Information
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NPI Number | 1083509012
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Entity Type | Organization
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Legal Business Name | THE LIGHT COMMUNITY ACTION GROUP, LLC.
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 2506 JEFFERSON AVE STE 111
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-4502
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Country | US
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Telephone | 757-995-6036
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Fax | 757-527-2567
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Provider Business Mailing Address
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Address Line | 1 DRAPER CIR
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City | HAMPTON
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State | VA
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Zip | 23666-5025
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. IDELL WALKER
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Credential |
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Telephone | 757-753-3153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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