Lichtenwalter, Mary Kathleen
Lichtenwalter, Mary Kathleen is an sole proprietor health care provider with primary practice located at 1730 Dunlawton Ave Suite #3, Port Orange FL 32127-8985. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Lichtenwalter, Mary Kathleen can be contacted via phone (386) 957-3905.Contact Information
Primary practice address
1730 Dunlawton Ave Suite #3
Port Orange FL 32127-8985
Phone: (386) 957-3905
Fax: (386) 402-8992
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | MH10712 | Florida |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 39001980A | Indiana |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | LCAC 870056A | Indiana |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | CAP 5276 | Florida |
Profile Details
| NPI number | 1326104001 |
|---|---|
| LBN Legal business name | Lichtenwalter, Mary Kathleen |
| Credentials | LMHC, CAP, CCS |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 28th, 2006 |
| Last updated | Dec 18th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326104001 | NPPES |
| Indiana | MEDICAID | 200196900A |
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