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General NPI Number Information
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NPI Number | 1295916617
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Entity Type | Organization
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Legal Business Name | THE LIGHTHOUSE COUNSELING CLINIC, INC.
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 1514 ROCK QUARRY RD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5047
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Country | US
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Telephone | 770-474-1946
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Fax | 770-389-9310
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Provider Business Mailing Address
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Address Line | 1514 ROCK QUARRY RD
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-5047
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Country | US
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Telephone | 770-474-1946
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Fax | 770-389-9310
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Authorized Official
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Title or Position | CEO
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Name | DR. LUANN CALLAWAY
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Credential | PH.D.
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Telephone | 770-474-1946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 00958545
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | GA
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