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General NPI Number Information
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NPI Number | 1760733497
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE FAMILY COUNSELING CENTER
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 223 SCENIC HWY STE 101
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5603
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Country | US
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Telephone | 678-637-1182
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Fax | 770-972-4123
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Provider Business Mailing Address
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Address Line | 223 SCENIC HWY STE 101
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5603
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Country | US
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Telephone | 678-637-1182
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Fax | 770-972-4123
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | DR. SONJA R NEWBERRY
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Credential | LPC
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Telephone | 678-637-1182
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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 | LPC0005907
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License Number State | GA
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