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General NPI Number Information
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NPI Number | 1124447503
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Entity Type | Organization
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Legal Business Name | LIFE FORCE DEVELOPMENT CENTER
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 9430 LANDIS DR
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City | BEAUMONT
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State | TX
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Zip | 77707-1153
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Country | US
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Telephone | 409-651-3702
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Fax |
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Provider Business Mailing Address
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Address Line | 9430 LANDIS DR
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City | BEAUMONT
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State | TX
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Zip | 77707-1153
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Country | US
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Telephone | 409-651-3702
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KIMBERLY ROCHELLE DELUNA
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Credential | LCDC
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Telephone | 409-651-3702
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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 | 11621
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License Number State | TX
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