Healthcare Provider Details

I. General information

NPI: 1326569039
Provider Name (Legal Business Name): LIGHTHOUSE WELLNESS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SQUIRREL HILL LANE
READFIELD ME
04355
US

IV. Provider business mailing address

PO BOX 368
READFIELD ME
04355-0368
US

V. Phone/Fax

Practice location:
  • Phone: 813-468-9711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC13280
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KRISTIE SNIFFEN
Title or Position: OWNER
Credential: LCSW
Phone: 813-468-9711