Provider Demographics
NPI:1437983376
Name:LIGHT OF RESILIENCE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:LIGHT OF RESILIENCE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNACEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-982-2405
Mailing Address - Street 1:10926 DAVID TAYLOR DRIVE
Mailing Address - Street 2:SUITE 120, PMB1220
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:980-982-2405
Mailing Address - Fax:
Practice Address - Street 1:10926 DAVID TAYLOR DRIVE
Practice Address - Street 2:SUITE 120, PMB1220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:252-363-8048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty