Provider Demographics
NPI:1285367565
Name:LIGHT AND LOVE COUNSELING GROUP LLC
Entity type:Organization
Organization Name:LIGHT AND LOVE COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:CTLC, CPC, CPAC
Authorized Official - Phone:410-497-5173
Mailing Address - Street 1:7000 GOLDEN RING RD UNIT 9564
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-7603
Mailing Address - Country:US
Mailing Address - Phone:410-497-5173
Mailing Address - Fax:
Practice Address - Street 1:4100 MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35808-3007
Practice Address - Country:US
Practice Address - Phone:256-200-2153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty