Provider Demographics
NPI:1639288517
Name:LIGHT, CAROLE S (PND)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:S
Last Name:LIGHT
Suffix:
Gender:F
Credentials:PND
Other - Prefix:MRS
Other - First Name:CAROLE
Other - Middle Name:LIGHT
Other - Last Name:REDMOUNTAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:318 LAKESIDE RD
Mailing Address - City:SCALY MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28775-0099
Mailing Address - Country:US
Mailing Address - Phone:828-526-9769
Mailing Address - Fax:828-526-8719
Practice Address - Street 1:318 LAKESIDE RD
Practice Address - Street 2:
Practice Address - City:SCALY MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28775-0099
Practice Address - Country:US
Practice Address - Phone:828-526-9769
Practice Address - Fax:828-526-8719
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1604103TC0700X
GA297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1163WOtherBCBS NC