Provider Demographics
NPI:1407529977
Name:GUIDEN LIGHT, LLC
Entity Type:Organization
Organization Name:GUIDEN LIGHT, LLC
Other - Org Name:GLT COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:SUZETTE
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-926-0262
Mailing Address - Street 1:809 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-1001
Mailing Address - Country:US
Mailing Address - Phone:757-926-0262
Mailing Address - Fax:757-273-6842
Practice Address - Street 1:809 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-1001
Practice Address - Country:US
Practice Address - Phone:757-926-0262
Practice Address - Fax:757-273-6842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty