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General NPI Number Information
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NPI Number | 1649096637
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Entity Type | Organization
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Legal Business Name | ILLUMINATING PATHWAYS LLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 3186 SHARPSVILLE RD
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City | LYNCHBURG
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State | OH
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Zip | 45142-9342
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Country | US
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Telephone | 937-725-9708
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Fax |
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Provider Business Mailing Address
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Address Line | 3186 SHARPSVILLE RD
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City | LYNCHBURG
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State | OH
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Zip | 45142-9342
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Country | US
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Telephone | 937-725-9708
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Fax |
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Authorized Official
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Title or Position | OWNER/ ADMINISTRATION/PROVIDER
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Name | ROBIN SMALLEY
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Credential | LPC
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Telephone | 937-725-9708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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