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Organization

PORCHLIGHT CUSTOM COUNSELING LLC

Active
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Organization

PORCHLIGHT CUSTOM COUNSELING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICA RICHARDS LMHC (PART OWNER)
(503) 395-3301
Entity
Organization

Contact information

Practice address
455 S KNOTT ST, CANBY, OR 97013-4426
(503) 395-3301
Mailing address
PO BOX 344, TURNER, OR 97392-0344
(503) 395-3301

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—

Other

Enumeration date
10/18/2018
Last updated
10/18/2018
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