Provider Demographics
NPI:1073600284
Name:LIT CANDLES CONSUMER CENTERED SERVICES
Entity Type:Organization
Organization Name:LIT CANDLES CONSUMER CENTERED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, QP
Authorized Official - Phone:910-323-8116
Mailing Address - Street 1:5194 REMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1254
Mailing Address - Country:US
Mailing Address - Phone:910-429-0482
Mailing Address - Fax:910-429-0482
Practice Address - Street 1:3115 BORDEAUX PARK DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2894
Practice Address - Country:US
Practice Address - Phone:910-323-8116
Practice Address - Fax:910-323-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management