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General NPI Number Information
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NPI Number | 1932984382
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Entity Type | Organization
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Legal Business Name | THE LUMAN PROJECT
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 2629 COLD STREAM LN
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City | GREEN COVE SPRINGS
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State | FL
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Zip | 32043-8623
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Country | US
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Telephone | 904-863-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 US HIGHWAY 17 # 18-418
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-8231
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Country | US
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Telephone | 904-863-6001
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MARYAM ARCHER
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Credential | LCSW
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Telephone | 425-280-6715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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