Organization
MARA'S LIGHTHOUSE COUNSELING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE INGENITO (CREDENTIALING SPECIALISTS)
(570) 352-3063
Entity
Organization
Contact information
Practice address
6015 MORROW ST E STE 109, JACKSONVILLE, FL 32217-2125
(904) 990-8105
(904) 562-3359
Mailing address
6015 MORROW ST E STE 109, JACKSONVILLE, FL 32217-2125
(904) 990-8105
(904) 562-3359
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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