Organization
SHINING LIGHT BEHAVIORAL HEALTH - WHITTAKER
Active
Parent organization
SHINING LIGHT BEHAVIORAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
SHINING LIGHT BEHAVIORAL
Authorized official
MR. WESLEY E MASON III (CEO)
(757) 434-1828
Entity
Organization
Contact information
Practice address
9524 WHITTAKER DR, GLOUCESTER, VA 23061-4527
(757) 453-5960
Mailing address
500 E MAIN ST STE 1600-65, NORFOLK, VA 23510-2205
(757) 434-1828
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251J00000X
Nursing Care Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261Q00000X
Clinic/Center
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
03/20/2024
Last updated
03/20/2024
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