person
Mary Kathleen Lichtenwalter, LMHC,CAP,CCS
Addiction (Substance Use Disorder) Counselor in Port Orange, Florida
NPI 1326104001

Mary Kathleen Lichtenwalter is an Addiction (Substance Use Disorder) Counselor based in Port Orange, FL and is specialized in Addiction (Substance Use Disorder). Mary Kathleen Lichtenwalter practices in Port Orange, FL and has the professional credentials of LMHC,CAP,CCS. The NPI Number for Mary Kathleen Lichtenwalter is 1326104001 and holds a License No. MH10712 (Florida).

The current practice location address for Mary Kathleen Lichtenwalter is 1730 Dunlawton Ave, Port Orange, FL and can be reached out via phone at 386-957-3905 and via fax at 386-402-8992.

Location: 1730 Dunlawton Ave, Port Orange, FL, 32127-8985
person
Provider Profile Details
NPI Number
1326104001
Provider Name
Mary Kathleen Lichtenwalter
Credential
LMHC,CAP,CCS
Provider Entity Type
Individual
Gender
Female
Address
1730 Dunlawton Ave, Port Orange, FL, 32127-8985
Phone Number
386-957-3905
Fax Number
386-402-8992
Provider Enumeration Date
12/28/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
200196900A 05 IN
institution
Provider Business Practice Location Address Details
Address
1730 Dunlawton Ave
City
State
Zip
32127-8985
Phone Number
386-957-3905
Fax Number
386-402-8992
person
Provider Business Mailing Address Details
Address
1730 Dunlawton Ave
City
State
Zip
32127-8985
Phone Number
386-957-3905
Fax Number
386-402-8992
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
39001980A (Indiana)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
MH10712 (Florida)
Definition
Definition to come...
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