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Organization
RADIANT LIGHT BEHAVIORAL CONCEPTS, LLC
Active
Organization
RADIANT LIGHT BEHAVIORAL CONCEPTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OMAR S LONG (CEO)
(908) 447-0931
Entity
Organization
Contact information
Practice address
625 E 2ND AVE, GASTONIA, NC 28054-0470
(908) 447-0931
Mailing address
301 W MAIN AVE # 2752, GASTONIA, NC 28052-4173
(908) 447-0931
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2174
NC
101YM0800X
Mental Health Counselor
2436
NC
101YM0800X
Mental Health Counselor
C001640
NC
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/16/2018
Last updated
06/28/2019
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