Healthcare Provider Details

I. General information

NPI: 1417148420
Provider Name (Legal Business Name): LIFECHANGES FAMILY GUIDANCE & WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 MLK JR. DRIVE
WINSTON SALEM NC
27107-1361
US

IV. Provider business mailing address

1922 S MARTIN LUTHER KING JR DR STE 15
WINSTON SALEM NC
27107-1371
US

V. Phone/Fax

Practice location:
  • Phone: 336-776-3154
  • Fax: 336-464-2071
Mailing address:
  • Phone: 336-464-1322
  • Fax: 888-320-8093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateSC

VIII. Authorized Official

Name: MRS. LATRINA DEVONNE WINFORD
Title or Position: CEO
Credential: LPCS, LCMHCS
Phone: 336-577-6652