Provider Demographics
NPI:1609359744
Name:LIGHTHOUSE COUNSELING SERVICES LCSW PLLC
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING SERVICES LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:716-680-8101
Mailing Address - Street 1:112 W MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-2149
Mailing Address - Country:US
Mailing Address - Phone:716-680-8101
Mailing Address - Fax:716-680-8102
Practice Address - Street 1:112 W MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-2149
Practice Address - Country:US
Practice Address - Phone:716-680-8101
Practice Address - Fax:716-680-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)