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General NPI Number Information
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NPI Number | 1396938262
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Entity Type | Organization
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Legal Business Name | NEW LIGHT CONSULTANTS
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 8511 STATE RD
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City | MILLINGTON
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State | MI
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Zip | 48746-9446
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Country | US
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Telephone | 989-871-6695
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Fax | 989-871-3663
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Provider Business Mailing Address
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Address Line | PO BOX 359 8511 STATE ST.
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City | MILLINGTON
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State | MI
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Zip | 48746-0359
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Country | US
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Telephone | 989-871-6695
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Fax | 989-871-3663
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RICHARD O WATKINS JR.
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Credential | MSW LMSW
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Telephone | 989-871-6695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 790026
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 790026
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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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 | 790026
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License Number State | MI
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