Provider Demographics
NPI:1205961232
Name:LIGHTHOUSE COUNSELING PC
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-251-5873
Mailing Address - Street 1:121 JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263
Mailing Address - Country:US
Mailing Address - Phone:770-251-5873
Mailing Address - Fax:770-304-2201
Practice Address - Street 1:121 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263
Practice Address - Country:US
Practice Address - Phone:770-251-5873
Practice Address - Fax:770-304-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002899101YP2500X
GAPSY002042103TC0700X
GAPSY002820103TC0700X
GAPSY001469103TC0700X
GAPSY002947103TC0700X
GAPSY002610103TC0700X
GALPC003462101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00727658CMedicaid
GA00458818DMedicaid
GA00964598AMedicaid
GA00458818DMedicaid
GA00964598AMedicaid
GA68BBGRGMedicare ID - Type UnspecifiedGLENDA BOYD
GA68BBFTHMedicare ID - Type UnspecifiedTHOMAS FREEMAN
GA00727658CMedicaid