Provider Demographics
NPI:1134409618
Name:GUIDING LIGHT FAMILY COUNSELING
Entity type:Organization
Organization Name:GUIDING LIGHT FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC LCAS CS-I NCC
Authorized Official - Phone:704-880-4003
Mailing Address - Street 1:18135 W CATAWBA AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5641
Mailing Address - Country:US
Mailing Address - Phone:704-880-4003
Mailing Address - Fax:704-880-4003
Practice Address - Street 1:18135 W CATAWBA AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5641
Practice Address - Country:US
Practice Address - Phone:704-880-4003
Practice Address - Fax:704-880-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-28
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1682101YA0400X
NC7986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty