Healthcare Provider Details

I. General information

NPI: 1285244210
Provider Name (Legal Business Name): LIFE CHANGING COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 CEDAR POND CT
KNIGHTDALE NC
27545-6063
US

IV. Provider business mailing address

449 CEDAR POND CT
KNIGHTDALE NC
27545-6063
US

V. Phone/Fax

Practice location:
  • Phone: 919-247-7198
  • Fax:
Mailing address:
  • Phone: 919-752-7118
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: BRITTNEY WILLIAMSON
Title or Position: OUTPATIENT THERAPIST
Credential: MA, LCMHC
Phone: 919-752-7118