Provider Demographics
NPI:1760733497
Name:LIGHTHOUSE FAMILY COUNSELING CENTER
Entity Type:Organization
Organization Name:LIGHTHOUSE FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-637-1182
Mailing Address - Street 1:223 SCENIC HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5603
Mailing Address - Country:US
Mailing Address - Phone:678-637-1182
Mailing Address - Fax:770-972-4123
Practice Address - Street 1:223 SCENIC HWY STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5603
Practice Address - Country:US
Practice Address - Phone:678-637-1182
Practice Address - Fax:770-972-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC0005907251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health