Provider Demographics
NPI:1114552692
Name:INNER LIGHT COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:INNER LIGHT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAZINAKIS-SWAINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-698-3804
Mailing Address - Street 1:4195 CASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2309
Mailing Address - Country:US
Mailing Address - Phone:727-773-7804
Mailing Address - Fax:
Practice Address - Street 1:4195 CASTLE AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-2309
Practice Address - Country:US
Practice Address - Phone:727-773-7804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty