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General NPI Number Information
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NPI Number | 1245773167
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Entity Type | Organization
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Legal Business Name | LIFE PROVISIONS, LLC.
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Dates
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Enumeration Date | 11/25/2016
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 2025 EBENEZER RD STE J4
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City | ROCK HILL
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State | SC
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Zip | 29732-1079
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Country | US
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Telephone | 704-300-4273
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 EBENEZER RD STE J4
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City | ROCK HILL
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State | SC
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Zip | 29732-1079
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Country | US
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Telephone | 704-300-4273
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIEF EXECUTIVE OFFICER
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Name | CASSANDRA DEMETRIA BELL
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Credential | MED., LPC
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Telephone | 704-300-4273
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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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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