Organization
LIGHTED PATH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY LYNN DICICCO MA, LAC, CRC (PRESIDENT)
(804) 592-1205
Entity
Organization
Contact information
Practice address
1124 OAK ST, SUITE 250, CONWAY, AR 72032-4318
(804) 592-1205
(866) 388-8128
Mailing address
PO BOX 224, SUITE 250, CONWAY, AR 72033-0224
(804) 592-1205
(866) 388-8128
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/04/2010
Last updated
07/09/2010
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