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General NPI Number Information
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NPI Number | 1043857618
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Entity Type | Organization
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Legal Business Name | LIFE SOLUTIONS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 01/12/2020
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Provider Practice Location Address
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Address Line | 146 PIERCE AVE
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City | MACON
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State | GA
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Zip | 31204-2871
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Country | US
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Telephone | 478-796-2947
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Fax | 478-210-2170
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Provider Business Mailing Address
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Address Line | 146 PIERCE AVE
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City | MACON
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State | GA
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Zip | 31204-2871
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Country | US
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Telephone | 478-796-2947
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Fax | 478-210-2170
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Authorized Official
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Title or Position | CLINICIAN
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Name | MRS. JACQUELINE JACKSON
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Credential | LCSW
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Telephone | 478-796-2947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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