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General NPI Number Information
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NPI Number | 1326879990
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE TREATMENT CENTERS OF GEORGIA LLC
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 37 KIKER ST
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City | ELLIJAY
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State | GA
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Zip | 30540-3758
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Country | US
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Telephone | 706-636-5483
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Fax | 706-636-5495
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Provider Business Mailing Address
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Address Line | 37 KIKER ST
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City | ELLIJAY
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State | GA
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Zip | 30540-3758
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Country | US
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Telephone | 706-636-5483
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Fax | 706-636-5495
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Authorized Official
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Title or Position | COO
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Name | DONNA LOUHICHI
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Credential |
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Telephone | 706-636-5483
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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