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General NPI Number Information
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NPI Number | 1023838265
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Entity Type | Organization
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Legal Business Name | LACTATION LIGHTHOUSE, LLC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 905 W 11 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3103
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Country | US
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Telephone | 734-224-5471
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Fax |
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Provider Business Mailing Address
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Address Line | 905 W 11 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-3103
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Country | US
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Telephone | 734-224-5471
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Fax |
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Authorized Official
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Title or Position | OWNER/IBCLC
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Name | CHRISTINA JOHNSON
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Credential | BSPH, IBCLC
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Telephone | 734-224-5471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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License Number State |
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