Lighthouse Addiction Services | |
3596 Tamiami Trl Ste 205 Port Charlotte FL 33952-8252 | |
(941) 255-5900 | |
(941) 764-8285 |
Full Name | Lighthouse Addiction Services |
---|---|
Speciality | Counselor - Addiction (substance Use Disorder) |
Location | 3596 Tamiami Trl Ste 205, Port Charlotte, Florida |
Authorized Official Name and Position | Barry K Wyrick (CHIEF OPERATING OFFICER) |
Authorized Official Contact | 9412555900 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Lighthouse Addiction Services 3596 Tamiami Trl Ste 205 Port Charlotte FL 33952-8252 Ph: (941) 255-5900 | Lighthouse Addiction Services 3596 Tamiami Trl Ste 205 Port Charlotte FL 33952-8252 Ph: (941) 255-5900 |
NPI Number | 1164822193 |
---|---|
Provider Enumeration Date | 08/27/2014 |
Last Update Date | 08/27/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164822193 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | 2008AD655206 (Florida) | Primary |
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
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