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General NPI Number Information
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NPI Number | 1427573351
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE ABA, PLLC
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 08/11/2017
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Provider Practice Location Address
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Address Line | 7211 WALKING HORSE CT
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City | WILMINGTON
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State | NC
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Zip | 28411-7438
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Country | US
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Telephone | 910-228-3091
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11403
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City | WILMINGTON
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State | NC
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Zip | 28404-1403
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Country | US
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Telephone | 910-228-3091
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Fax |
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Authorized Official
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Title or Position | FOUNDER & BEHAVIOR ANALYST
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Name | MRS. KRISTIN LEIGH MUMPOWER
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Credential | LPA, BCBA
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Telephone | 910-228-3091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4583
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-13055
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License Number State | NC
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