Provider Demographics
NPI:1912688813
Name:DIVINE LIGHT COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:DIVINE LIGHT COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-692-3285
Mailing Address - Street 1:2800 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7236
Mailing Address - Country:US
Mailing Address - Phone:479-692-3285
Mailing Address - Fax:
Practice Address - Street 1:2800 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7236
Practice Address - Country:US
Practice Address - Phone:479-692-3285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty