| Lighthouse Counseling & Life Skills Center | |
|
7209 Hamilton Acres Cir Chattanooga TN 37421-8623 | |
| (423) 499-9335 | |
| (423) 499-9334 |
| Full Name | Lighthouse Counseling & Life Skills Center |
|---|---|
| Speciality | Counselor |
| Location | 7209 Hamilton Acres Cir, Chattanooga, Tennessee |
| Authorized Official Name and Position | Mark Carpenter (DIRECTOR) |
| Authorized Official Contact | 4234999335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Counseling & Life Skills Center 7209 Hamilton Acres Cir Chattanooga TN 37421-8623 Ph: (423) 499-9335 | Lighthouse Counseling & Life Skills Center 7209 Hamilton Acres Cir Chattanooga TN 37421-8623 Ph: (423) 499-9335 |
| NPI Number | 1518117597 |
|---|---|
| Provider Enumeration Date | 09/25/2008 |
| Last Update Date | 07/21/2021 |
| Certification Date | 07/21/2021 |
| Medicare PECOS PAC ID | 6800137209 |
|---|---|
| Medicare Enrollment ID | O20210805003112 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518117597 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | John W Oldham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770635708 PECOS PAC ID: 9830189711 Enrollment ID: I20040513000654 |
| Provider Name | Ella G Ford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205972395 PECOS PAC ID: 1355670258 Enrollment ID: I20190830002284 |
| Provider Name | Leslie Kay |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558098285 PECOS PAC ID: 5395183115 Enrollment ID: I20240329000632 |
| Provider Name | Abby Wallace |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1376897694 PECOS PAC ID: 0941640148 Enrollment ID: I20240506001094 |
| Provider Name | Stephanie Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992268106 PECOS PAC ID: 0941640072 Enrollment ID: I20240506003952 |
| Provider Name | Dedra Spradling |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447648761 PECOS PAC ID: 8729428867 Enrollment ID: I20240506004092 |
| Provider Name | Mark Carpenter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851566509 PECOS PAC ID: 8527309921 Enrollment ID: I20240506004229 |
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