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General NPI Number Information
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NPI Number | 1952035735
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE DEVELOPMENTAL SERVICES LLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 690 N REILLY RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5724
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Country | US
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Telephone | 910-624-9884
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Fax |
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Provider Business Mailing Address
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Address Line | 3566 ROLLS AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-2424
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Country | US
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Telephone | 910-624-9884
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SYLVIA HAMMETT
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Credential |
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Telephone | 910-624-9884
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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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