=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487453130
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FROM DARKNESS TO LIGHT COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 04/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 ASBURY RD NE
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-804-1998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 412 ASBURY RD NE
-----------------------------------------------------
City | RIO RANCHO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87124-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-804-1998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. VIRGINIA GARCIA
-----------------------------------------------------
Credential | LMSW, LADAC
-----------------------------------------------------
Telephone | 505-804-1998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------