| Southlight Counseling Pllc | |
|
2 Cardinal Park Dr Se Ste 105a Leesburg VA 20175-4448 | |
| (571) 233-2302 | |
| Not Available |
| Full Name | Southlight Counseling Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2 Cardinal Park Dr Se Ste 105a, Leesburg, Virginia |
| Authorized Official Name and Position | Ellen Labgold (PROVIDER) |
| Authorized Official Contact | 5712332302 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlight Counseling Pllc 2 Cardinal Park Dr Se Ste 105a Leesburg VA 20175-4448 Ph: (571) 233-2302 | Southlight Counseling Pllc 2 Cardinal Park Dr Se Ste 105a Leesburg VA 20175-4448 Ph: (571) 233-2302 |
| NPI Number | 1992436653 |
|---|---|
| Provider Enumeration Date | 06/22/2022 |
| Last Update Date | 06/22/2022 |
| Certification Date | 06/22/2022 |
| Medicare PECOS PAC ID | 1557737954 |
|---|---|
| Medicare Enrollment ID | O20221025003500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992436653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ellen Kathleen Labgold |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104391622 PECOS PAC ID: 8224443544 Enrollment ID: I20210219000361 |
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