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NPI Code Detail

MEDICARE: LIGHTHOUSE BEHAVIORAL HEALTH CENTER, LLC

MEDICARE: LIGHTHOUSE BEHAVIORAL HEALTH CENTER, LLC
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
1101YP2500XProfessional Counselor
21041C0700XClinical Social Worker
3251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1982952545
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGHTHOUSE BEHAVIORAL HEALTH CENTER, LLC
Provider Business Mailing Address
First Line : 8310 MIDLOTHIAN TPKE
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23235-5163
Country : US
Telephone Number : 804-447-6382
Fax Number : 804-447-6383
Provider Business Practice Location Address
First Line : 8310 MIDLOTHIAN TPKE
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23235-5163
Country : US
Telephone Number : 804-447-6382
Fax Number : 804-447-6383
Authorized Official
Title or Position : CEO
Name : ROBYN LOWRY JENNINGS
Credential :
Telephone Number : 804-447-6382
Provider Enumeration Date : 08/29/2012
Last Update Date : 11/11/2021

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