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General NPI Number Information
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NPI Number | 1528703949
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Entity Type | Organization
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Legal Business Name | RADIANT CHRISTIAN COUNSELING, LLC
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 2101 N LAKEWOOD DR STE 222
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2473
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Country | US
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Telephone | 208-274-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 N LAKEWOOD DR STE 222
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2473
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Country | US
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Telephone | 208-274-3320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADAM ROBICHAUD
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Credential |
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Telephone | 208-274-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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