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NPI Code Detail

MEDICARE: PORCH LIGHT COUNSELING, LLC

MEDICARE: PORCH LIGHT COUNSELING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1649135245
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORCH LIGHT COUNSELING, LLC
Provider Business Mailing Address
First Line : 327 DAHLONEGA ST STE A601
Second Line :
City : CUMMING
State : GA
Zip : 30040-2488
Country : US
Telephone Number : 470-253-1090
Fax Number :
Provider Business Practice Location Address
First Line : 327 DAHLONEGA ST STE A601
Second Line :
City : CUMMING
State : GA
Zip : 30040-2488
Country : US
Telephone Number : 470-253-1090
Fax Number :
Authorized Official
Title or Position : OWNER
Name : GRACYN PAIGE WISTOSKI JENNINGS
Credential : M.ED., LPC
Telephone Number : 470-253-1090
Provider Enumeration Date : 12/17/2025
Last Update Date : 12/17/2025

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Directions to “PORCH LIGHT COUNSELING, LLC ” Practice Location

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