MEDICARE: LIGHTHOUSE FOUNDATIONS COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417817933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE FOUNDATIONS COUNSELING

Provider Business Mailing Address
First Line	:	5309 MONROE RD STE 110
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5309 MONROE RD STE 110
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7829
Country	:	US
Telephone Number	:	704-774-5284
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	COURTNEY CRAVEN
Credential	:	LCMHC
Telephone Number	:	833-657-4951

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	11/17/2025

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