MEDICARE: LUMEN PSYCHIATRY PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1689509010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMEN PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	9723 NORTHCROSS CENTER CT STE K
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9723 NORTHCROSS CENTER CT STE K
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7301
Country	:	US
Telephone Number	:	860-208-7525
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JOY ILABOR
Credential	:
Telephone Number	:	860-208-7525

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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