Provider Demographics
NPI:1568899722
Name:A LIGHT OF HOPE SUPPORT CENTER
Entity Type:Organization
Organization Name:A LIGHT OF HOPE SUPPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED INTERN
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:STUNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA MFT
Authorized Official - Phone:661-689-4996
Mailing Address - Street 1:23780 NEWHALL AVE
Mailing Address - Street 2:201
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3125
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23780 NEWHALL AVE
Practice Address - Street 2:201
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-3125
Practice Address - Country:US
Practice Address - Phone:661-689-4996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75656251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health