Healthcare Provider Details

I. General information

NPI: 1558534305
Provider Name (Legal Business Name): LIGHTHOUSE THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30838 VINES CREEK RD SUITE 2B
DAGSBORO DE
19939-4385
US

IV. Provider business mailing address

30838 VINES CREEK RD SUITE 2B
DAGSBORO DE
19939-4385
US

V. Phone/Fax

Practice location:
  • Phone: 302-732-1310
  • Fax:
Mailing address:
  • Phone: 302-732-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000820
License Number StateDE

VIII. Authorized Official

Name: MS. DEBORAH ALIOTO MILLER
Title or Position: THERAPIST OWNER
Credential: LCSW
Phone: 302-732-1310