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General NPI Number Information
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NPI Number | 1235543448
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Entity Type | Organization
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Legal Business Name | LIFE SUPPORT COUNSELING, PLLC
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 690 N REILLY RD SUITE # 214
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5724
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Country | US
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Telephone | 443-985-0541
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Fax |
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Provider Business Mailing Address
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Address Line | 18 BOSTON HBR
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City | CAMERON
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State | NC
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Zip | 28326-6238
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Country | US
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Telephone | 443-985-0541
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MS. HILARY WATSON
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Credential | LCSW
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Telephone | 443-985-0541
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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 | C007545
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License Number State | NC
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