| Lighthouse Counseling Christian Ministry, Llc | |
|
314 Franklin Ave Ste 403 Berlin MD 21811-1263 | |
| (410) 973-2211 | |
| (443) 782-0350 |
| Full Name | Lighthouse Counseling Christian Ministry, Llc |
|---|---|
| Speciality | Counselor |
| Location | 314 Franklin Ave Ste 403, Berlin, Maryland |
| Authorized Official Name and Position | Christopher W Tabb (OWNER/ THERAPIST) |
| Authorized Official Contact | 4108082291 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Counseling Christian Ministry, Llc 314 Franklin Ave Ste 403 Berlin MD 21811-1263 Ph: (410) 973-2211 | Lighthouse Counseling Christian Ministry, Llc 314 Franklin Ave Ste 403 Berlin MD 21811-1263 Ph: (410) 973-2211 |
| NPI Number | 1104272426 |
|---|---|
| Provider Enumeration Date | 05/05/2016 |
| Last Update Date | 07/25/2023 |
| Certification Date | 07/25/2023 |
| Medicare PECOS PAC ID | 1456615079 |
|---|---|
| Medicare Enrollment ID | O20180508001437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104272426 | NPI | - | NPPES |
| 436905000 | Medicaid | MD | |
| 23332 | Other | MD | MARYLAND LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LC6686 (Maryland) | Primary |
| 101YP2500X | Counselor - Professional | PC0000480 (Delaware) | Secondary |
| Provider Name | Deborah E Smithson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134312259 PECOS PAC ID: 6507841608 Enrollment ID: I20040622001558 |
| Provider Name | Jeffrey Byrne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033571534 PECOS PAC ID: 3375809478 Enrollment ID: I20171106001929 |
| Provider Name | Carly Banks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467900803 PECOS PAC ID: 8527453547 Enrollment ID: I20220309002231 |
| Provider Name | Rochelle Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770804783 PECOS PAC ID: 8729254388 Enrollment ID: I20230827000023 |
| Provider Name | Veron Corneil Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538435318 PECOS PAC ID: 4880025386 Enrollment ID: I20240108003986 |
| Provider Name | Jeff Biele |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821450768 PECOS PAC ID: 9830541051 Enrollment ID: I20240123003353 |
| Provider Name | Christopher W Tabb |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396167912 PECOS PAC ID: 7618329855 Enrollment ID: I20240123003941 |
| Provider Name | Lisa Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063275873 PECOS PAC ID: 8820434202 Enrollment ID: I20240307002079 |
| Provider Name | Pamela Shay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346671559 PECOS PAC ID: 1759721475 Enrollment ID: I20240429002334 |
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