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General NPI Number Information
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NPI Number | 1114042652
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Entity Type | Organization
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Legal Business Name | LIFE STAGES COUNSELING CENTER, INC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 14 CANDLEWOOD PATH
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City | DIX HILLS
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State | NY
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Zip | 11746-5304
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Country | US
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Telephone | 516-617-2635
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Fax | 631-462-6499
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Provider Business Mailing Address
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Address Line | 14 CANDLEWOOD PATH
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City | DIX HILLS
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State | NY
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Zip | 11746-5304
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Country | US
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Telephone | 516-617-2635
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Fax | 631-462-6499
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Authorized Official
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Title or Position | LICENSED FAMILY THERAPIST/PARTNER
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Name | MS. TERESA GRELLA HILLEBRAND
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Credential | LMFT
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Telephone | 516-617-2635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6464
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000155-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 074243-1
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License Number State | NY
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