Light Source LLC
NPI #1902454689 in Belleville, Illinois
Provider Information
- NPI Number
- 1902454689
- Entity Type
- Organization
- Organization Name
- Light Source LLC
- Primary Specialty
- Social Worker - Clinical
- Enumeration Date
- Aug 27, 2019
- Last Updated
- Aug 27, 2019
Practice Location
- Address
- 114 E LINCOLN ST
- City
- Belleville
- State
- Illinois
- ZIP Code
- 62220-2251
- Phone
- (618) 444-9934
Authorized Official
- Name
- CHARLES FRANKE
- Title
- LCSW/OWNER
- Phone
- (618) 444-9934
Specialties & Taxonomy Codes
| Specialty |
|---|
| Social Worker - Clinical — Clinical |
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