=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255065231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIGHTHOUSE BEACON CHURCH BEACON INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2022
-----------------------------------------------------
Last Update Date | 07/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | WARRIOR WAY WELLNESS CENTER 469 MCLAWS CIRCLE
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-384-9325
-----------------------------------------------------
Fax | 804-201-4816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | WARRIOR WAY WELLNESS CENTER 469 MCLAWS CIRCLE
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-384-9325
-----------------------------------------------------
Fax | 804-201-4816
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ TRUSTEE
-----------------------------------------------------
Name | MRS. SHARON F SCHLERF
-----------------------------------------------------
Credential | MA CISM BA COUNSELIN
-----------------------------------------------------
Telephone | 804-384-9325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------