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General NPI Number Information
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NPI Number | 1528453263
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Entity Type | Organization
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Legal Business Name | LIGHT HOUSE PROFESSIONAL COUNSELING
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 1315 N SANDHILLS BLVD
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City | ABERDEEN
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State | NC
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Zip | 28315-2211
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Country | US
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Telephone | 910-551-4461
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Fax |
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Provider Business Mailing Address
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Address Line | 312 SAINT MATTHEWS CHURCH RD
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City | RAEFORD
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State | NC
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Zip | 28376-7840
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Country | US
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Telephone | 910-551-4461
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KIMBERLY DEON MCGREGOR
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Credential | LCAS
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Telephone | 910-551-4461
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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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