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General NPI Number Information
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NPI Number | 1982187068
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE CLINICAL COUNSELING, LLC
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 3883 ROGERS BRIDGE ROAD SUITE 601
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City | DULUTH
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State | GA
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Zip | 30097
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Country | US
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Telephone | 770-329-5405
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Fax |
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Provider Business Mailing Address
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Address Line | 3883 ROGERS BRIDGE ROAD SUITE 601
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City | DULUTH
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State | GA
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Zip | 30097
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Country | US
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Telephone | 770-329-5405
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Fax |
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Authorized Official
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Title or Position | EXECTIVE DIR/CEOECTOR
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Name | MS. FAITHE BREANNE KIMSEY
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Credential | MS, LPC, NCC
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Telephone | 770-329-5405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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