Healthcare Provider Details

I. General information

NPI: 1396246922
Provider Name (Legal Business Name): LAMPLIGHT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 YORK ST UNIT 201H
BIDDEFORD ME
04005-5531
US

IV. Provider business mailing address

51 WILD DUNES WAY UNIT 13
OLD ORCHARD BEACH ME
04064-4156
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-1097
  • Fax:
Mailing address:
  • Phone: 207-317-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberXL4797
License Number StateME

VIII. Authorized Official

Name: MRS. MASHELLE LOUISE KRIER
Title or Position: OWNER
Credential: LCPC-C
Phone: 207-317-0049