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General NPI Number Information
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NPI Number | 1922768258
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Entity Type | Organization
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Legal Business Name | MY GUIDING LIGHT PLLC
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 1412 DUNBROOK DR
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City | WINTERVILLE
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State | NC
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Zip | 28590-5812
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Country | US
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Telephone | 252-227-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 3141 N CONTENTNEA ST
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City | FARMVILLE
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State | NC
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Zip | 27828-1477
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Country | US
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Telephone | 252-320-6868
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | ROSE MARIE LAWRENCE
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Credential | LCMHC
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Telephone | 252-227-9373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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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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