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General NPI Number Information
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NPI Number | 1770232928
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Entity Type | Organization
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Legal Business Name | LIVING LIGHT HOLISTIC COUNSELING
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 6114 RICKWOOD AVE
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City | HUNTSVILLE
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State | AL
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Zip | 35810
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Country | US
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Telephone | 256-588-3989
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Fax |
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Provider Business Mailing Address
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Address Line | 9889 SW 54TH AVE
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City | OCALA
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State | FL
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Zip | 34476-8694
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Country | US
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Telephone | 601-896-5363
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LILLY NELSON MAXWELL
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Credential | LICSW, LPN, MSW
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Telephone | 601-896-5363
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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 |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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