| Mara's Lighthouse Counseling Center, Llc | |
|
6015 Morrow St E Ste 114 Jacksonville FL 32217-2125 | |
| (904) 990-8105 | |
| (904) 562-3359 |
| Full Name | Mara's Lighthouse Counseling Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 6015 Morrow St E Ste 114, Jacksonville, Florida |
| Authorized Official Name and Position | Shamara D Gibson (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9049908105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mara's Lighthouse Counseling Center, Llc 6015 Morrow St E Ste 114 Jacksonville FL 32217-2125 Ph: (904) 990-8105 | Mara's Lighthouse Counseling Center, Llc 6015 Morrow St E Ste 114 Jacksonville FL 32217-2125 Ph: (904) 990-8105 |
| NPI Number | 1407478613 |
|---|---|
| Provider Enumeration Date | 05/11/2020 |
| Last Update Date | 06/16/2020 |
| Certification Date | 06/16/2020 |
| Medicare PECOS PAC ID | 1759724206 |
|---|---|
| Medicare Enrollment ID | O20240212002491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407478613 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shamara Gibson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598140733 PECOS PAC ID: 2668815119 Enrollment ID: I20240212002671 |
| Provider Name | Tamara Mckenzie |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558807701 PECOS PAC ID: 4587000617 Enrollment ID: I20240312002567 |
| Provider Name | Diamond Tiara Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518545797 PECOS PAC ID: 4880032812 Enrollment ID: I20240409004309 |
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