Provider Demographics
NPI:1356171771
Name:PATH TO LIGHT COUNSELING LLC
Entity type:Organization
Organization Name:PATH TO LIGHT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:GUEST
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LPC/S, LAC, CS
Authorized Official - Phone:843-942-9597
Mailing Address - Street 1:1629 RUBY RD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-2407
Mailing Address - Country:US
Mailing Address - Phone:843-942-9597
Mailing Address - Fax:843-326-4816
Practice Address - Street 1:1629 RUBY RD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-2407
Practice Address - Country:US
Practice Address - Phone:843-942-9597
Practice Address - Fax:843-326-4816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1374Medicaid