Provider Demographics
NPI:1558902072
Name:RAY OF LIGHT COUNSELING SERVICE LLC
Entity Type:Organization
Organization Name:RAY OF LIGHT COUNSELING SERVICE LLC
Other - Org Name:RAY OF LIGHT COUNSELING SERVICE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S
Authorized Official - Phone:318-639-0765
Mailing Address - Street 1:112 E CAROLINA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3898
Mailing Address - Country:US
Mailing Address - Phone:318-639-0765
Mailing Address - Fax:318-341-2181
Practice Address - Street 1:112 E CAROLINA AVE STE D
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3898
Practice Address - Country:US
Practice Address - Phone:318-639-0765
Practice Address - Fax:318-314-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-06
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)