Provider Demographics
NPI:1104272426
Name:LIGHTHOUSE COUNSELING CHRISTIAN MINISTRY, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING CHRISTIAN MINISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:TABB
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-808-2291
Mailing Address - Street 1:314 FRANKLIN AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1263
Mailing Address - Country:US
Mailing Address - Phone:410-973-2211
Mailing Address - Fax:443-782-0350
Practice Address - Street 1:314 FRANKLIN AVE STE 403
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1263
Practice Address - Country:US
Practice Address - Phone:410-973-2211
Practice Address - Fax:443-782-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000480101YP2500X
MDLC6686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23332OtherMARYLAND LICENSE
MD436905000Medicaid