Provider Demographics
NPI:1982187068
Name:LIGHTHOUSE CLINICAL COUNSELING, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE CLINICAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIR/CEOECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FAITHE
Authorized Official - Middle Name:BREANNE
Authorized Official - Last Name:KIMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:770-329-5405
Mailing Address - Street 1:3883 ROGERS BRIDGE ROAD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-329-5405
Mailing Address - Fax:
Practice Address - Street 1:3883 ROGERS BRIDGE ROAD
Practice Address - Street 2:SUITE 601
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-329-5405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty