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General NPI Number Information
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NPI Number | 1376701979
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Entity Type | Organization
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Legal Business Name | GREEN LIGHT COUNSELING INC
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 415 N EDGEWORTH ST # 205
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City | GREENSBORO
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State | NC
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Zip | 27401-2071
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Country | US
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Telephone | 336-335-0585
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Fax | 336-335-5710
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Provider Business Mailing Address
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Address Line | PO BOX 2141
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City | JAMESTOWN
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State | NC
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Zip | 27282-8800
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Country | US
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Telephone | 336-335-0585
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Fax | 336-335-5710
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Authorized Official
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Title or Position | CEO OWNER
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Name | MR. JASON WILLIAM STRACK
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Credential | LPC
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Telephone | 336-335-0585
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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 | 5149
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License Number State | NC
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