Healthcare Provider Details

I. General information

NPI: 1013013473
Provider Name (Legal Business Name): LIFE ENRICHMENT COUNSELING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LAND O PINES CIRCLE
MONCKS CORNER SC
29461
US

IV. Provider business mailing address

130 LAND O PINES CIRCLE
MONCKS CORNER SC
29461
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-7446
  • Fax: 843-761-7446
Mailing address:
  • Phone: 843-761-7446
  • Fax: 843-761-7446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. GAYLE P JOURDAIN
Title or Position: PRESIDENT
Credential: LPC
Phone: 843-761-7446