Provider Demographics
NPI:1053024851
Name:SUNLIT PATH THERAPY
Entity type:Organization
Organization Name:SUNLIT PATH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-222-3032
Mailing Address - Street 1:4650 43RD PL N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-3420
Mailing Address - Country:US
Mailing Address - Phone:941-400-7879
Mailing Address - Fax:
Practice Address - Street 1:51 S MAIN AVE STE 304
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3937
Practice Address - Country:US
Practice Address - Phone:727-784-8244
Practice Address - Fax:727-287-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW15496OtherFL DEPARTMENT OF HEALTH