Provider Demographics
NPI:1962087122
Name:GUIDING LIGHT HOLISTIC CARE AND COUNSELING
Entity type:Organization
Organization Name:GUIDING LIGHT HOLISTIC CARE AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEDRA
Authorized Official - Middle Name:LITTLE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:229-938-9573
Mailing Address - Street 1:546 GA HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-9307
Mailing Address - Country:US
Mailing Address - Phone:229-938-9573
Mailing Address - Fax:
Practice Address - Street 1:546 GA HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-9307
Practice Address - Country:US
Practice Address - Phone:229-938-9573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty