Healthcare Provider Details

I. General information

NPI: 1548856842
Provider Name (Legal Business Name): CENTER FOR LIFE ENRICHMENT, ADVANCEMENT, AND RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 ALTA DR
VALPARAISO IN
46385-8562
US

IV. Provider business mailing address

1325 W 98TH AVE
CROWN POINT IN
46307-2465
US

V. Phone/Fax

Practice location:
  • Phone: 219-789-3423
  • Fax:
Mailing address:
  • Phone: 219-789-3423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLE B LEWIS
Title or Position: OWNER
Credential: MS, LMHC
Phone: 219-789-3423