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General NPI Number Information
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NPI Number | 1326268103
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE COUNSELING & SAND PLAY TRAINING CENTER, LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 615 HOPE RD BUILDING 3A
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City | EATONTOWN
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State | NJ
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Zip | 07724-1277
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Country | US
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Telephone | 732-380-1575
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Fax | 732-380-1578
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Provider Business Mailing Address
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Address Line | 615 HOPE RD BUILDING 3A
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City | EATONTOWN
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State | NJ
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Zip | 07724-1277
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Country | US
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Telephone | 732-380-1575
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Fax | 732-380-1578
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. GRETCHEN MORGAN
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Credential | MSW LCSW
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Telephone | 732-380-1575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04971400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04597600
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License Number State | NJ
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