=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194532887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUIDELIGHT HEALTH OF NORTH CAROLINA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2024
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6060 PIEDMONT ROW DR S STE 407
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28287-3884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-228-1774
-----------------------------------------------------
Fax | 704-270-8297
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6060 PIEDMONT ROW DR S STE 407
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28287-3884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-228-1774
-----------------------------------------------------
Fax | 704-270-8297
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ADMINISTRATIVE OFFICER
-----------------------------------------------------
Name | CHARLES SPOSATO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-249-3557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------