| Lighthouse Wellness Group | |
|
1301 Plantation Island Dr S Ste 202a St Augustine FL 32080-3111 | |
| (904) 318-8500 | |
| Not Available |
| Full Name | Lighthouse Wellness Group |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1301 Plantation Island Dr S Ste 202a, St Augustine, Florida |
| Authorized Official Name and Position | Cooper T Moore (OWNER) |
| Authorized Official Contact | 9043188500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Wellness Group 1301 Plantation Island Dr S Ste 202a St Augustine FL 32080-3111 Ph: (904) 318-8500 | Lighthouse Wellness Group 1301 Plantation Island Dr S Ste 202a St Augustine FL 32080-3111 Ph: (904) 318-8500 |
| NPI Number | 1114739604 |
|---|---|
| Provider Enumeration Date | 01/22/2025 |
| Last Update Date | 01/31/2025 |
| Certification Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114739604 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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