Into the Light Counseling, Inc.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C004198 Issued in NC

Legal business name

INTO THE LIGHT COUNSELING, INC.

Practice address

353 W 2ND St
Clayton, NC 27520-2336

Phone

(919) 271-0135

Fax

(888) 503-6822

NPI assigned

Oct 2, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrea Eaves, LCSWNPI 1700837630

Title

Owner/Therapist

Phone

(919) 271-0135

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrea Eaves, LCSW

  • Clinical Social Worker
  • Clayton, NC
  • NPI 1700837630
  Medicare reassignment Care Compare group NPD Authorized official
• Carly Blystone

  • Clinical Social Worker
  • Smithfield, NC
  • NPI 1265389928
  Medicare reassignment Care Compare group NPD
• Jennifer Leigh-Ann Osterhoudt, MSW

  • Clinical Social Worker
  • Raleigh, NC
  • NPI 1609567510
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1689925562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1348",
            "address_2": "PO BOX 1348",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275281348",
            "telephone_number": "919-271-0135",
            "fax_number": "888-503-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 W 2ND ST",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275202336",
            "telephone_number": "919-271-0135",
            "fax_number": "888-503-6822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTO THE LIGHT COUNSELING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "EAVES",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "919-271-0135",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6003393",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "141C3",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "2860031A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• William Spencer Irving, LCMHC-A
• Monette Irwin, L.C.S.W.
• Alexis Jackson, MA, BCBA, LBA
• Carmesia Jackson
• Deja De'Shea Jackson, LCSWA

• Clinical Social Worker in Clayton, NC
• Providers in Clayton, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.