Healthcare Provider Details

I. General information

NPI: 1750539516
Provider Name (Legal Business Name): LIFECARE COUNSELING AND COACHING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 JONES FRANKLIN RD SUITE 104
RALEIGH NC
27606-3379
US

IV. Provider business mailing address

1601 JONES FRANKLIN RD SUITE 104
RALEIGH NC
27606-3379
US

V. Phone/Fax

Practice location:
  • Phone: 919-851-1527
  • Fax: 919-851-3555
Mailing address:
  • Phone: 919-851-1527
  • Fax: 919-851-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6654
License Number StateNC

VIII. Authorized Official

Name: MR. GERALD W LANKFORD
Title or Position: PRESIDENT
Credential: MACC, MBA, MDIV, LPC
Phone: 919-851-1527