Healthcare Provider Details

I. General information

NPI: 1306546940
Provider Name (Legal Business Name): COMPLETE LIFE SERVICES LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G3500 FLUSHING RD STE 244
FLINT MI
48504-4257
US

IV. Provider business mailing address

511 HICKORY HALL LN
GOOSE CREEK SC
29445-6348
US

V. Phone/Fax

Practice location:
  • Phone: 813-943-5323
  • Fax:
Mailing address:
  • Phone: 813-943-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SEON F THOMPSON
Title or Position: CLINICAL DIRECTOR
Credential: LICSW, BCD
Phone: 813-943-5323