Provider Demographics
NPI:1740426139
Name:LIGHT, DON C (CADC II)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:C
Last Name:LIGHT
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 BELL EXECUTIVE LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4068
Mailing Address - Country:US
Mailing Address - Phone:916-922-9217
Mailing Address - Fax:916-922-0072
Practice Address - Street 1:2316 BELL EXECUTIVE LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4068
Practice Address - Country:US
Practice Address - Phone:916-922-9217
Practice Address - Fax:916-922-0072
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3776101101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor