Provider Demographics
NPI:1528453263
Name:LIGHT HOUSE PROFESSIONAL COUNSELING
Entity type:Organization
Organization Name:LIGHT HOUSE PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DEON
Authorized Official - Last Name:MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:910-551-4461
Mailing Address - Street 1:312 SAINT MATTHEWS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7840
Mailing Address - Country:US
Mailing Address - Phone:910-551-4461
Mailing Address - Fax:
Practice Address - Street 1:1315 N SANDHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2211
Practice Address - Country:US
Practice Address - Phone:910-551-4461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health