Healthcare Provider Details

I. General information

NPI: 1871235101
Provider Name (Legal Business Name): STYLE OF LIFE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5042 NIGHT STAR TRL
ODESSA FL
33556-4575
US

IV. Provider business mailing address

5042 NIGHT STAR TRL
ODESSA FL
33556-4575
US

V. Phone/Fax

Practice location:
  • Phone: 203-414-1854
  • Fax:
Mailing address:
  • Phone: 203-414-1854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE COULTER FAIFMAN
Title or Position: OWNER
Credential: LMHC
Phone: 203-414-1854