Provider Demographics
NPI:1043025026
Name:THE GUIDING LIGHT WELLNESS CENTER
Entity type:Organization
Organization Name:THE GUIDING LIGHT WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRARE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:267-341-7136
Mailing Address - Street 1:623 S CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21826-1505
Mailing Address - Country:US
Mailing Address - Phone:267-341-7136
Mailing Address - Fax:
Practice Address - Street 1:623 S CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:MD
Practice Address - Zip Code:21826-1505
Practice Address - Country:US
Practice Address - Phone:267-341-7136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-08
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty