Provider Demographics
NPI:1871251025
Name:LIGHTNER, JACINTA
Entity Type:Individual
Prefix:
First Name:JACINTA
Middle Name:
Last Name:LIGHTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 ANTHONI AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6403
Mailing Address - Country:US
Mailing Address - Phone:304-242-6722
Mailing Address - Fax:
Practice Address - Street 1:210 ANTHONI AVE STE 300
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6403
Practice Address - Country:US
Practice Address - Phone:304-242-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician