MEDICARE: JOURNEY TO LIFE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	757	NC

General Provider Information

NPI Number	:	1396725347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY TO LIFE, INC

Provider Business Mailing Address
First Line	:	1801 E 5TH ST
Second Line	:	STE. 212
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2472
Country	:	US
Telephone Number	:	704-332-5433
Fax Number	:	704-366-6119

Provider Business Practice Location Address
First Line	:	1801 E 5TH ST
Second Line	:	STE. 213
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2472
Country	:	US
Telephone Number	:	704-332-5433
Fax Number	:	704-366-6119

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ALEXIS J STEIN
Credential	:	LPC
Telephone Number	:	704-332-5433

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	04/28/2015

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Directions to “JOURNEY TO LIFE, INC ” Practice Location

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