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General NPI Number Information
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NPI Number | 1023402823
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Entity Type | Organization
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Legal Business Name | LIFETIME COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 916 ARSENAL AVE B
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5328
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Country | US
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Telephone | 910-864-0390
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Fax | 910-864-0396
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Provider Business Mailing Address
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Address Line | 916 ARSENAL AVE B
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5328
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Country | US
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Telephone | 910-864-0390
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Fax | 910-864-0396
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR/OWNER
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Name | MRS. SHIRLEY EVON TAYBRON
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Credential | M.ED, LPCS, NBCC
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Telephone | 910-864-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | S2018
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License Number State | NC
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