Organization
LIGHTHOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DREW CARBERRY (EXECUTIVE DIRECTOR)
(410) 788-5483
Entity
Organization
Contact information
Practice address
60 MELLOR AVE, BALTIMORE, MD 21228-5104
(410) 788-5483
(410) 788-5486
Mailing address
60 MELLOR AVE, BALTIMORE, MD 21228-5104
(410) 788-5483
(410) 788-5486
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BD70
CAREFIRST BCBS
MD
Enumeration date
10/07/2013
Last updated
06/11/2015
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