Provider Demographics
NPI:1962012153
Name:WILDLIGHT COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:WILDLIGHT COUNSELING SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANEL
Authorized Official - Middle Name:MEREDITH
Authorized Official - Last Name:FALVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMHC
Authorized Official - Phone:717-725-3943
Mailing Address - Street 1:185 DAYDREAM AVE APT 7307
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-5483
Mailing Address - Country:US
Mailing Address - Phone:912-421-8668
Mailing Address - Fax:
Practice Address - Street 1:340 EISENHOWER DR BLDG 300
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1600
Practice Address - Country:US
Practice Address - Phone:912-421-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC010078OtherSTATE LICENSE NUMBER FOR GEORGIA
FLMH20243OtherLMHC
PAPC007377OtherPENNSYLVANIA COUNSELING LICENSE