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General NPI Number Information
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NPI Number | 1114080447
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Entity Type | Organization
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Legal Business Name | LIGHT THE WAY COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 662 GOFFLE RD SUITE #1
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City | HAWTHORNE
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State | NJ
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Zip | 07506-3420
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Country | US
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Telephone | 973-636-9600
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Fax | 973-636-9608
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Provider Business Mailing Address
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Address Line | 662 GOFFLE RD SUITE #1
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City | HAWTHORNE
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State | NJ
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Zip | 07506-3420
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Country | US
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Telephone | 973-636-9600
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Fax | 973-636-9608
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Authorized Official
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Title or Position | DIRECTOR
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Name | MISS CYNTHIA LOUISE PICHT
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Credential | MA, LPC
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Telephone | 973-636-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00142100
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License Number State | NJ
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