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General NPI Number Information
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NPI Number | 1922237270
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE PSYCH CONSULTING
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 1601 WEHUNT PL SE
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City | SMYRNA
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State | GA
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Zip | 30082-4845
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Country | US
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Telephone | 678-761-4106
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 WEHUNT PL SE
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City | SMYRNA
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State | GA
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Zip | 30082-4845
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Country | US
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Telephone | 678-761-4106
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | WILLIAM ANDREW THORNTON
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Credential | APRN-BC
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Telephone | 678-761-4106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN166395-NP
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License Number State | GA
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