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General NPI Number Information
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NPI Number | 1083338032
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Entity Type | Organization
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Legal Business Name | LIFEPATH HOLISTIC COUNSELING AND CONSULTING, PLLC.
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 104 WAXHAW PROFESSIONAL PARK DR STE D
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City | WAXHAW
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State | NC
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Zip | 28173-5020
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Country | US
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Telephone | 704-899-1555
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Fax |
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Provider Business Mailing Address
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Address Line | 104 WAXHAW PROFESSIONAL PARK DR STE D
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City | WAXHAW
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State | NC
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Zip | 28173-5020
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Country | US
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Telephone | 704-899-1555
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL MENTAL HEALTH COU
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Name | JENNY RENVILLE
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Credential | LCMHCA, NCC
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Telephone | 704-899-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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