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General NPI Number Information
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NPI Number | 1487146510
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Entity Type | Organization
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Legal Business Name | PACK LIGHT COUNSELING, LLC
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 08/30/2018
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Provider Practice Location Address
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Address Line | 9157 ATLEE RD STE A
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City | MECHANICSVILLE
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State | VA
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Zip | 23116
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Country | US
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Telephone | 540-314-5811
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Fax | 844-236-4057
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Provider Business Mailing Address
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Address Line | 7264 MERLE SMITH LN
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-5029
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Country | US
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Telephone | 540-314-5811
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Fax | 844-236-4057
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Authorized Official
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Title or Position | OWNER
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Name | MS. ASHLEE CHANTEL MURPHY
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Credential | LCSW
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Telephone | 540-314-5811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904010374
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License Number State | VA
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