Lichtenwalter, Mary Kathleen

Lichtenwalter, Mary Kathleen is an sole proprietor health care provider with primary practice located at 3930 S Nova Rd Ste 307 , Port Orange FL 32127-9293. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Lichtenwalter, Mary Kathleen can be contacted via phone (386) 795-7996.

Contact Information

Primary practice address
3930 S Nova Rd Ste 307 Port Orange FL 32127-9293
Phone: (386) 795-7996
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X LCAC 870056A Indiana
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 39001980A Indiana
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X CAP 5276 Florida
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH10712 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 Oct 15th, 2025 - about last year

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326104001 NPPES
Indiana MEDICAID 200196900A

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