Provider Demographics
NPI:1700505286
Name:FAMILY LIGHT COUNSELING AND PSYCHIATRY
Entity Type:Organization
Organization Name:FAMILY LIGHT COUNSELING AND PSYCHIATRY
Other - Org Name:FAMILY LIGHT COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARANJA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:443-525-7199
Mailing Address - Street 1:1702 TAYLOR AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1702 TAYLOR AVE STE D
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-6153
Practice Address - Country:US
Practice Address - Phone:443-525-7199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty