Provider Demographics
NPI:1992459119
Name:LUMEN GUIDANCE & CONSULTATION, LLC
Entity type:Organization
Organization Name:LUMEN GUIDANCE & CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-415-5446
Mailing Address - Street 1:3715 NORTHSIDE PKWY
Mailing Address - Street 2:BLDG 100 - STE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2886
Mailing Address - Country:US
Mailing Address - Phone:770-415-5446
Mailing Address - Fax:
Practice Address - Street 1:3715 NORTHSIDE PKWY
Practice Address - Street 2:BLDG 100 - STE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2886
Practice Address - Country:US
Practice Address - Phone:770-415-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1225780869Medicaid