Provider Demographics
NPI:1275226938
Name:RADIANT LIFE COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:RADIANT LIFE COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MAMFT, LMFT, LPC
Authorized Official - Phone:650-450-0775
Mailing Address - Street 1:1820 THE EXCHANGE SE STE 750
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2088
Mailing Address - Country:US
Mailing Address - Phone:770-769-2796
Mailing Address - Fax:
Practice Address - Street 1:1820 THE EXCHANGE SE STE 750
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2088
Practice Address - Country:US
Practice Address - Phone:770-769-2796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty