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NPI Code Detail

MEDICARE: THE LIGHTHOUSE COUNSELING CLINIC, INC.

MEDICARE: THE LIGHTHOUSE COUNSELING CLINIC, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency00958545GA
2251S00000XCommunity/Behavioral Health AgencyGA

General Provider Information

NPI Number : 1295916617
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE LIGHTHOUSE COUNSELING CLINIC, INC.
Provider Business Mailing Address
First Line : 1514 ROCK QUARRY RD
Second Line :
City : STOCKBRIDGE
State : GA
Zip : 30281-5047
Country : US
Telephone Number : 770-474-1946
Fax Number : 770-389-9310
Provider Business Practice Location Address
First Line : 1514 ROCK QUARRY RD
Second Line :
City : STOCKBRIDGE
State : GA
Zip : 30281-5047
Country : US
Telephone Number : 770-474-1946
Fax Number : 770-389-9310
Authorized Official
Title or Position : CEO
Name : DR. LUANN CALLAWAY
Credential : PH.D.
Telephone Number : 770-474-1946
Provider Enumeration Date : 11/14/2007
Last Update Date : 11/14/2007

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Directions to “THE LIGHTHOUSE COUNSELING CLINIC, INC. ” Practice Location

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