Provider Demographics
NPI:1134735202
Name:LIGHTHOUSE FAMILY SERVICE CENTER
Entity type:Organization
Organization Name:LIGHTHOUSE FAMILY SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WIDLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALAMBERT-DUCENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-419-6404
Mailing Address - Street 1:150 STANLEY CT STE B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 STANLEY CT STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5215
Practice Address - Country:US
Practice Address - Phone:404-419-6404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty