Provider Demographics
NPI:1932724713
Name:RESTORING LIGHT COUNSELING, LLC
Entity type:Organization
Organization Name:RESTORING LIGHT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEULEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-332-8913
Mailing Address - Street 1:248 EAGLE BEND WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2990
Mailing Address - Country:US
Mailing Address - Phone:318-332-8913
Mailing Address - Fax:
Practice Address - Street 1:3018 OLD MINDEN RD STE 1113E
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-2476
Practice Address - Country:US
Practice Address - Phone:318-332-8913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty