Provider Demographics
NPI:1518735554
Name:SHARE LIGHT BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:SHARE LIGHT BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AFOLASHADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-985-7511
Mailing Address - Street 1:3100 LORD BALTIMORE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-5804
Mailing Address - Country:US
Mailing Address - Phone:443-985-7511
Mailing Address - Fax:410-645-8393
Practice Address - Street 1:3100 LORD BALTIMORE DR STE 101
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-5804
Practice Address - Country:US
Practice Address - Phone:443-985-7511
Practice Address - Fax:410-645-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty