Provider Demographics
NPI:1073312104
Name:RADIANT LIFE COUNSELING CENTER PLLC
Entity type:Organization
Organization Name:RADIANT LIFE COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:BRITANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC-A, LCAS-A
Authorized Official - Phone:910-691-4864
Mailing Address - Street 1:2310 H BULLARD RD
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-7932
Mailing Address - Country:US
Mailing Address - Phone:910-691-4864
Mailing Address - Fax:
Practice Address - Street 1:219 DICK ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5727
Practice Address - Country:US
Practice Address - Phone:910-691-4864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty