Provider Demographics
NPI:1962990770
Name:BEYOND LIGHT
Entity type:Organization
Organization Name:BEYOND LIGHT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYWANIA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:FLETCHER-LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CAC11
Authorized Official - Phone:202-236-4852
Mailing Address - Street 1:1030 KEARNY ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3518
Mailing Address - Country:US
Mailing Address - Phone:202-236-4852
Mailing Address - Fax:202-529-6629
Practice Address - Street 1:1030 KEARNY ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-529-9299
Practice Address - Fax:202-529-6626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON FOUNDATION FOR FAMILY LIFE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-26
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty