Healthcare Provider Details

I. General information

NPI: 1144125030
Provider Name (Legal Business Name): LIFE RIDGE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 QUICKSILVER TRL
FORT MILL SC
29708-6548
US

IV. Provider business mailing address

740 QUICKSILVER TRL
FORT MILL SC
29708-6548
US

V. Phone/Fax

Practice location:
  • Phone: 704-497-1860
  • Fax:
Mailing address:
  • Phone: 704-497-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ALISSA MYNHIER
Title or Position: COUNSELOR
Credential: LPC, LCMHC
Phone: 704-497-1860