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General NPI Number Information
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NPI Number | 1326104001
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Entity Type | Individual
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Provider Name | MARY KATHLEEN LICHTENWALTER LMHC, CAP, CCS
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Gender | Female
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 3930 S NOVA RD STE 307
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City | PORT ORANGE
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State | FL
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Zip | 32127-9293
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Country | US
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Telephone | 386-795-7996
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 MARILYN ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-5123
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Country | US
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Telephone | 386-795-7996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCAC 870056A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39001980A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP 5276
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH10712
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License Number State | FL
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