Provider Demographics
NPI:1053444885
Name:LIGHT TO MY PATH THERAPEUTIC SERVICES INC.
Entity Type:Organization
Organization Name:LIGHT TO MY PATH THERAPEUTIC SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-455-1922
Mailing Address - Street 1:99 VILLAGE DR STE 15
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7060
Mailing Address - Country:US
Mailing Address - Phone:910-455-1922
Mailing Address - Fax:910-455-1921
Practice Address - Street 1:99 VILLAGE DR STE 15
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7060
Practice Address - Country:US
Practice Address - Phone:910-455-1922
Practice Address - Fax:910-455-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301134Medicaid