Provider Demographics
NPI:1215405832
Name:GUIDING LIGHT FAMILY SERVICES, LLC
Entity Type:Organization
Organization Name:GUIDING LIGHT FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARQUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-724-3758
Mailing Address - Street 1:425 S MAIN ST UNIT I&J
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-2300
Mailing Address - Country:US
Mailing Address - Phone:757-724-3758
Mailing Address - Fax:
Practice Address - Street 1:425 S MAIN ST UNIT I&J
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-2300
Practice Address - Country:US
Practice Address - Phone:757-724-3758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA261QM0801XMedicaid