Provider Demographics
NPI:1689925562
Name:INTO THE LIGHT COUNSELING, INC.
Entity Type:Organization
Organization Name:INTO THE LIGHT COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-271-0135
Mailing Address - Street 1:PO BOX 1348
Mailing Address - Street 2:PO BOX 1348
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-1348
Mailing Address - Country:US
Mailing Address - Phone:919-271-0135
Mailing Address - Fax:888-503-6822
Practice Address - Street 1:353 W 2ND ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2336
Practice Address - Country:US
Practice Address - Phone:919-271-0135
Practice Address - Fax:888-503-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003393Medicaid
141C3OtherBCBS
2860031AOtherMEDICARE