Provider Demographics
NPI:1306650189
Name:LIGHTHOUSE THERAPEUTICS
Entity type:Organization
Organization Name:LIGHTHOUSE THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMISHA
Authorized Official - Middle Name:HAYES
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-360-6164
Mailing Address - Street 1:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-1420
Mailing Address - Country:US
Mailing Address - Phone:803-900-4020
Mailing Address - Fax:803-753-9362
Practice Address - Street 1:437A HIGHWAY 601 S
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-8918
Practice Address - Country:US
Practice Address - Phone:803-900-4020
Practice Address - Fax:803-753-9362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty