Provider Demographics
NPI:1639408263
Name:LIGHTHOUSE ADDICTION SERVICES
Entity Type:Organization
Organization Name:LIGHTHOUSE ADDICTION SERVICES
Other - Org Name:HARBOR COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:WILLIAM, CARL
Authorized Official - Last Name:ROPKE
Authorized Official - Suffix:IV
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:941-255-5900
Mailing Address - Street 1:3596 TAMIAMI TRL STE 205
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8252
Mailing Address - Country:US
Mailing Address - Phone:941-255-5900
Mailing Address - Fax:941-764-8285
Practice Address - Street 1:3596 TAMIAMI TRL
Practice Address - Street 2:SUITE 205
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8263
Practice Address - Country:US
Practice Address - Phone:941-255-5900
Practice Address - Fax:941-764-8285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBOR COUNSELING AND LIGHTHOUSE ADDICTION SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2008AD0345-00101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty