Provider Demographics
NPI:1689058687
Name:SALT & LIGHT COUNSELING LLC
Entity Type:Organization
Organization Name:SALT & LIGHT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-829-2523
Mailing Address - Street 1:110 HABERSHAM DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1381
Mailing Address - Country:US
Mailing Address - Phone:678-829-2523
Mailing Address - Fax:
Practice Address - Street 1:110 HABERSHAM DR
Practice Address - Street 2:SUITE 109
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1381
Practice Address - Country:US
Practice Address - Phone:678-829-2523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty