Provider Demographics
NPI:1710277629
Name:INNER LIGHT CONSULTING AND THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:INNER LIGHT CONSULTING AND THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC, MA
Authorized Official - Phone:202-321-9367
Mailing Address - Street 1:13132 GRANDVIEW CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5224
Mailing Address - Country:US
Mailing Address - Phone:202-321-9367
Mailing Address - Fax:
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:202-321-9367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty