I. C. Lightstone | |
11949 Bricksome Ave Ste C Baton Rouge LA 70816-2595 | |
(225) 443-2083 | |
(225) 666-0444 |
Full Name | I. C. Lightstone |
---|---|
Speciality | Counselor |
Location | 11949 Bricksome Ave Ste C, Baton Rouge, Louisiana |
Authorized Official Name and Position | Charlotte Gilmore (OWNER) |
Authorized Official Contact | 2254432083 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
I. C. Lightstone 6142 Tennyson Dr Baton Rouge LA 70817-2937 Ph: (504) 275-9020 | I. C. Lightstone 11949 Bricksome Ave Ste C Baton Rouge LA 70816-2595 Ph: (225) 443-2083 |
NPI Number | 1861140824 |
---|---|
Provider Enumeration Date | 03/17/2022 |
Last Update Date | 04/25/2024 |
Certification Date | 04/25/2024 |
Medicare PECOS PAC ID | 8325485808 |
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Medicare Enrollment ID | O20240607001930 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861140824 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Charlotte H Gilmore |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1497249825 PECOS PAC ID: 9234576711 Enrollment ID: I20240607001989 |
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