Healthcare Provider Details

I. General information

NPI: 1578067930
Provider Name (Legal Business Name): LIGHTHOUSE CLINICAL SOCIAL WORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W DUBLIN DR STE 202
MADISON AL
35758-3157
US

IV. Provider business mailing address

120 W DUBLIN DR STE 202
MADISON AL
35758-3157
US

V. Phone/Fax

Practice location:
  • Phone: 256-929-5507
  • Fax: 888-440-7284
Mailing address:
  • Phone: 256-929-5507
  • Fax: 888-440-7284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1626
License Number StateAL

VIII. Authorized Official

Name: DEBBIE KAY DUQUETTE
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: L.I.C.S.W., P.I.P.
Phone: 256-929-5507