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General NPI Number Information
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NPI Number | 1265257893
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Entity Type | Organization
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Legal Business Name | LOTUS OF LIFE COUNSELING, LLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 2501 CHATHAM RD STE R
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 317-643-1545
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Fax |
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Provider Business Mailing Address
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Address Line | 3049 SHOLTY CT
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City | CICERO
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State | IN
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Zip | 46034-9108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEIGH DEVINE
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Credential |
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Telephone | 317-643-1545
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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 |
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License Number State |
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