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General NPI Number Information
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NPI Number | 1881001576
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Entity Type | Organization
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Legal Business Name | LIGHTHORSE HEALTHCARE, INC.
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 2060 DAN PROCTOR DR SUITE 3300
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City | SAINT MARYS
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State | GA
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Zip | 31558-3894
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Country | US
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Telephone | 912-882-3800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5250
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City | SAINT MARYS
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State | GA
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Zip | 31558-5250
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Country | US
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Telephone | 912-882-3800
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. CARLENE TAYLOR
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Credential | ED.D, LPC, CPCS, NCC
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Telephone | 912-882-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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