Provider Demographics
NPI:1992033484
Name:LIGHT, ARTHUR RUDOLPH JR (MA, CSAC, CCS, LCAS)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:RUDOLPH
Last Name:LIGHT
Suffix:JR
Gender:M
Credentials:MA, CSAC, CCS, LCAS
Other - Prefix:
Other - First Name:ARTIE
Other - Middle Name:
Other - Last Name:LIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:405 NC HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-8882
Practice Address - Country:US
Practice Address - Phone:336-342-8316
Practice Address - Fax:336-342-8352
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22364101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1992033484Medicaid
NC19NXZOtherBCBS