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General NPI Number Information
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NPI Number | 1184242711
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Entity Type | Organization
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Legal Business Name | NEW LIFE GOALS, LLC
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 504 COOPER RD
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City | JACKSON
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State | MS
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Zip | 39212-4704
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Country | US
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Telephone | 601-300-3067
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Fax | 601-292-7066
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Provider Business Mailing Address
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Address Line | PO BOX 8113
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City | JACKSON
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State | MS
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Zip | 39284-8113
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Country | US
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Telephone | 601-300-3067
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Fax | 601-292-7066
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Authorized Official
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Title or Position | CEO
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Name | MRS. NADIA L. GAYNOR
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Credential | LPC
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Telephone | 601-300-3067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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