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MARA'S LIGHTHOUSE COUNSELING CENTER, LLC
NPI 1407478613
Social Worker - Clinical in Jacksonville, FL

Active since May 11, 2020CLIA 10D2335601 · Waiver
12086 FORT CAROLINE RD STE 201, JACKSONVILLE, FL 32225(904) 990-8105(904) 562-3359 Get Directions Write a Review

NPPES record last updated: November 18, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 18, 2025, Jun 16, 2020, May 11, 2020 (3 updates tracked since 2020).

About Mara's Lighthouse Counseling Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARA'S LIGHTHOUSE COUNSELING CENTER, LLC (NPI 1407478613) is a healthcare organization registered as a clinical in Jacksonville, Florida and active in the NPI registry since May 2020. The organization holds a CLIA Waiver certificate valid through December 14, 2027, maintains a secondary practice location in Orange Park, and lists Alex De Guzman, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1407478613
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameMARA'S LIGHTHOUSE COUNSELING CENTER, LLC
Location Address12086 FORT CAROLINE RD STE 201Jacksonville, FL 32225-2689
Mailing Address12086 Fort Caroline Rd Ste 201Jacksonville, FL 32225-2689 · (904) 990-8105 · Fax (904) 562-3359
Phone(904) 990-8105
Fax(904) 562-3359
Organization SubpartNo
Authorized OfficialAlex De GuzmanOffice Manager · (904) 990-8105
Enumeration DateMay 11, 2020
Last NPPES UpdateNovember 18, 20253 updates tracked since enumeration
NPPES CertifiedNovember 18, 2025
✔ NPI 1407478613 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
12086 FORT CAROLINE RD STE 201, Jacksonville, FL 32225
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Secondary Practice Location 1

Location 1108 Kingsley Ave Ste 212214Orange Park, FL 32073-5685 · Phone (904) 990-8105 · Fax (904) 562-3359

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mara's Lighthouse Counseling Center, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Mara's Lighthouse Counseling Center, LLC, which bills Medicare for the services they deliver. Of these, 5 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Ashley Martin, LCSW
Clinical Social Worker
NPI 1164196259
1385 BROOKWOOD FOREST BLVD APT 901
Jacksonville, FL 32225
(904) 349-7706
✔ PECOS✔ Accepts Medicare2.8 mi
Tameka Terry, APRN
Nurse Practitioner
NPI 1114685161
6501 ARLINGTON EXPY STE B105
Jacksonville, FL 32211
(904) 474-3996
✔ PECOS✔ Accepts Medicare6.0 mi
Tamara Mckenzie
Mental Health Counselor
NPI 1558807701
2320 N LIBERTY ST
Jacksonville, FL 32206
(904) 608-1775
✔ PECOS✔ Accepts Medicare8.6 mi
Bria Odom
Mental Health Counselor
NPI 1992389639
3027 SAN DIEGO RD
Jacksonville, FL 32207
(904) 493-7744
✔ PECOS9.2 mi
Shamara Gibson, LCSW
Clinical Social Worker
NPI 1598140733
921 N DAVIS ST BUILDING B, SUITE 315
Jacksonville, FL 32209
(904) 359-3857
✔ PECOS✔ Accepts Medicare9.7 mi
Diamond Williams, LMHC
Mental Health Counselor
NPI 1518545797
555 STOCKTON ST
Jacksonville, FL 32204
(904) 254-9597
✔ PECOS11 mi
Bernadette Taggart
Clinical Social Worker
NPI 1902629512
10935 LAKE DR
New Port Richey, FL 34654
(727) 534-3980
✔ PECOS157 mi
Magenta Hall, ARNP
Nurse Practitioner
NPI 1518465582
1010 CAPITAL CIRCLE SW
Tallahassee, FL 32304
(850) 755-6468
✔ PECOS✔ Accepts Medicare170 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2335601

Mara's Lighthouse Counseling Center LLC · Jacksonville, FL
Active · expires Dec 14, 2027
CLIA Number10D2335601
Laboratory TypePhysician Office
Certificate Effective DateDecember 15, 2025
Certificate Expiration DateDecember 14, 2027
Laboratory DirectorTameka Terry
Laboratory Phone(904) 990-8105
Laboratory LocationMara's Lighthouse Counseling Center LLC12086 Fort Caroline Rd Suite 201, Jacksonville, FL 32225
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mara's Lighthouse Counseling Center, LLC's NPI number?

The NPI number for Mara's Lighthouse Counseling Center, LLC is 1407478613. It was assigned to this organization in the NPPES registry on May 11, 2020.

Where is Mara's Lighthouse Counseling Center, LLC located?

Mara's Lighthouse Counseling Center, LLC is located at 12086 Fort Caroline Rd Ste 201, Jacksonville, FL 32225. The listed phone number is (904) 990-8105.

What is Mara's Lighthouse Counseling Center, LLC's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Mara's Lighthouse Counseling Center, LLC enrolled in Medicare?

Yes. Mara's Lighthouse Counseling Center, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mara's Lighthouse Counseling Center, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 3 Medicare specialties reassign their Medicare billing to Mara's Lighthouse Counseling Center, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Clinical Social Worker (3), Mental Health Counselor (3) and Nurse Practitioner (2). Of these, 5 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mara's Lighthouse Counseling Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2335601) is associated with this NPI, valid through December 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Mara's Lighthouse Counseling Center, LLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Mara's Lighthouse Counseling Center, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mara's Lighthouse Counseling Center, LLC was last updated on November 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.