Provider Demographics
NPI:1225579790
Name:LIGHTHOUSE COUNSELING OF FREDERICKSBURG, PLC
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING OF FREDERICKSBURG, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREINER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-907-0121
Mailing Address - Street 1:420 HUDGINS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-4172
Mailing Address - Country:US
Mailing Address - Phone:540-907-0121
Mailing Address - Fax:866-832-7890
Practice Address - Street 1:420 HUDGINS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4172
Practice Address - Country:US
Practice Address - Phone:540-907-0121
Practice Address - Fax:866-832-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty