Healthcare Provider Details

I. General information

NPI: 1568016111
Provider Name (Legal Business Name): YOUR WAY LIFE COACHING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E INNES ST STE 101
SALISBURY NC
28144-5100
US

IV. Provider business mailing address

530 E INNES ST STE 101
SALISBURY NC
28144-5100
US

V. Phone/Fax

Practice location:
  • Phone: 980-643-4030
  • Fax:
Mailing address:
  • Phone: 980-643-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: CONSTANCE EBOMAH
Title or Position: OWNER, DIRECTOR
Credential: MBA/HCM, CNLPMP, CBT
Phone: 980-643-4030