Provider Demographics
NPI:1487380440
Name:VOWS OF LIGHT, LLC
Entity type:Organization
Organization Name:VOWS OF LIGHT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ICELYLNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP, LCSW
Authorized Official - Phone:803-730-1023
Mailing Address - Street 1:2024 S WABASH AVE APT 306
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2283
Mailing Address - Country:US
Mailing Address - Phone:803-638-8373
Mailing Address - Fax:
Practice Address - Street 1:2024 S WABASH AVE APT 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2283
Practice Address - Country:US
Practice Address - Phone:803-638-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty