Provider Demographics
NPI:1578225231
Name:GUIDING LIGHT CHRISTIAN COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:GUIDING LIGHT CHRISTIAN COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICALS THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:319-382-8664
Mailing Address - Street 1:1221 PARK PL NE STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2019
Mailing Address - Country:US
Mailing Address - Phone:319-382-8664
Mailing Address - Fax:
Practice Address - Street 1:1221 PARK PL NE STE A
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2019
Practice Address - Country:US
Practice Address - Phone:319-382-8664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty