Organization
BRIDGE OF LIGHT LLC
Active
Other names
Breaking Barriers Together Health Group
Organization subpart
No
Provider details
NPI number
Authorized official
XANDER FAISON LCPC (OWNER)
(443) 991-1582
Entity
Organization
Contact information
Practice address
4512 SUNNYVIEW DR APT 178, OKLAHOMA CITY, OK 73135-3163
(443) 991-1582
Mailing address
4512 SUNNYVIEW DR APT 178, OKLAHOMA CITY, OK 73135-3163
(443) 991-1582
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Enumeration date
10/09/2024
Last updated
10/09/2024
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