Healthcare Provider Details

I. General information

NPI: 1265599021
Provider Name (Legal Business Name): LIFESCAPES COUNSELING ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W WILLIAMS ST SUITE 251
APEX NC
27502-5203
US

IV. Provider business mailing address

800 W WILLIAMS ST SUITE 251
APEX NC
27502-5203
US

V. Phone/Fax

Practice location:
  • Phone: 919-303-0273
  • Fax: 919-303-5986
Mailing address:
  • Phone: 919-303-0273
  • Fax: 919-303-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC0018
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier015E4
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS GROUP PROVIDER ID

VIII. Authorized Official

Name: MRS. AMY BENTON MOULDS
Title or Position: PRACTICE DIRECTOR & OWNER
Credential: M.ED., NCC, LPC
Phone: 919-303-0273