Healthcare Provider Details

I. General information

NPI: 1619312568
Provider Name (Legal Business Name): LIFEWISE CHRISTIAN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3977 51ST ST. S.
FARGO ND
58104
US

IV. Provider business mailing address

3977 51 ST STREET SOUTH
FARGO ND
58104-7895
US

V. Phone/Fax

Practice location:
  • Phone: 701-230-9286
  • Fax: 701-540-0050
Mailing address:
  • Phone: 701-491-8823
  • Fax: 701-540-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2807
License Number StateND

VIII. Authorized Official

Name: DARRIN L COX
Title or Position: OWNER / LCSW
Credential:
Phone: 701-491-8823