Provider Demographics
NPI:1336944396
Name:SALT & LIGHT LLC
Entity type:Organization
Organization Name:SALT & LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:718-213-0962
Mailing Address - Street 1:1021 EDEN WAY N STE 118
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2776
Mailing Address - Country:US
Mailing Address - Phone:757-844-9809
Mailing Address - Fax:
Practice Address - Street 1:1021 EDEN WAY N STE 118
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2776
Practice Address - Country:US
Practice Address - Phone:757-844-9809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)