Organization
LIGHTING THE WAY INTERVENTION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMIKA TASHELL CLARK LPC (CEO/OWNER)
(678) 596-3590
Entity
Organization
Contact information
Practice address
5875 WESTCHASE ST, ATLANTA, GA 30336-2912
(678) 596-3590
(404) 389-0885
Mailing address
4286 MEMORIAL DR, SUITE B, DECATUR, GA 30032-1221
(678) 596-3590
(404) 389-0885
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
GA
253Z00000X
In Home Supportive Care Agency
Primary
—
GA
Other
Enumeration date
08/27/2012
Last updated
08/27/2012
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