Provider Demographics
NPI:1578067930
Name:LIGHTHOUSE CLINICAL SOCIAL WORK, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE CLINICAL SOCIAL WORK, LLC
Other - Org Name:LIGHTHOUSE CLINICAL SOCIAL WORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DUQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, PIP
Authorized Official - Phone:256-929-5507
Mailing Address - Street 1:120 W DUBLIN DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3157
Mailing Address - Country:US
Mailing Address - Phone:256-929-5507
Mailing Address - Fax:888-440-7284
Practice Address - Street 1:120 W DUBLIN DR STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3157
Practice Address - Country:US
Practice Address - Phone:256-929-5507
Practice Address - Fax:888-440-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
AL1626251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
51526789OtherBCBS
11817512OtherCAQH
Q35592OtherUPIN
51527591OtherFEDERAL BCBS
1073552089OtherINDIVIDUAL NPI