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Organization
RADIANT LIGHT BEHAVIORAL SERVICES LLC
Active
Organization
RADIANT LIGHT BEHAVIORAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY DAVIS (CREDENTIALING SPECIALISTS)
(912) 373-4385
Entity
Organization
Contact information
Practice address
625 E 2ND AVE, GASTONIA, NC 28054-0470
(704) 222-2348
Mailing address
PO BOX 18361, CHARLOTTE, NC 28218-0361
(704) 222-2348
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/14/2021
Last updated
06/14/2021
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