# COLLEGE LAKES

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SHINELIGHT, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1841612215
- **Legal business name:** SHINELIGHT, INC.
- **Authorized official:** NIKKI GIOVANNI CREECY (CEO)
- **Authorized official phone:** (910) 257-6406

## Contact information

- **Practice address:** 5104 FLATROCK DRIVE, FAYETTEVILLE, NC 28311
- **Practice address phone:** (910) 488-6323
- **Practice address fax:** (910) 223-2180
- **Mailing address:** 5104 FLATROCK DRIVE, FAYETTEVILLE, NC 28311
- **Mailing address phone:** (910) 257-6406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL-047-133 | NC | Yes |

## Other

- **Enumeration date:** 01/20/2014
- **Last updated:** 04/21/2021