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General NPI Number Information
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NPI Number | 1033393822
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE COUNSELING, LLC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 100 S LIVE OAK ST
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City | GENEVA
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State | AL
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Zip | 36340-2215
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Country | US
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Telephone | 334-684-1045
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Fax | 334-684-1047
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Provider Business Mailing Address
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Address Line | 100 S LIVE OAK ST PO BOX 416
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City | GENEVA
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State | AL
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Zip | 36340-2215
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Country | US
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Telephone | 334-684-1045
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Fax | 334-684-1047
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Authorized Official
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Title or Position | CEO
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Name | MS. GWENDOLYN DOWNING
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Credential | MAE, LPC, CCDVFC
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Telephone | 334-684-1045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1393
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License Number State | AL
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