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General NPI Number Information
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NPI Number | 1386368850
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Entity Type | Organization
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Legal Business Name | I AM LIGHT
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 4813 CASTLE HILL RD
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City | RALEIGH
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State | NC
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Zip | 27616-6273
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Country | US
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Telephone | 910-301-7752
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Fax |
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Provider Business Mailing Address
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Address Line | 4813 CASTLE HILL RD
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City | RALEIGH
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State | NC
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Zip | 27616-6273
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Country | US
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Telephone | 910-301-7752
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANQUINARTA LEE
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Credential | B.A., MA ED., NCC
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Telephone | 910-301-7752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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