Provider Demographics
NPI:1972190189
Name:A LIGHT IN THE DARKNESS CLINICAL COUNSELING LLC
Entity Type:Organization
Organization Name:A LIGHT IN THE DARKNESS CLINICAL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:DATZ
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:614-369-8996
Mailing Address - Street 1:4218 ARBUTUS AVE
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3115
Mailing Address - Country:US
Mailing Address - Phone:624-369-8996
Mailing Address - Fax:
Practice Address - Street 1:4218 ARBUTUS AVE
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3115
Practice Address - Country:US
Practice Address - Phone:624-369-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health