Provider Demographics
NPI:1366917775
Name:ENLIGHTENMENT HEALTHCARE LLC
Entity type:Organization
Organization Name:ENLIGHTENMENT HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:LEWINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-554-4880
Mailing Address - Street 1:10901 BRIGHTON BAY BLVD NE APT 5107
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3462
Mailing Address - Country:US
Mailing Address - Phone:910-554-4880
Mailing Address - Fax:
Practice Address - Street 1:150 BW THOMAS DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7230
Practice Address - Country:US
Practice Address - Phone:910-554-4880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty