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General NPI Number Information
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NPI Number | 1306546940
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Entity Type | Organization
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Legal Business Name | COMPLETE LIFE SERVICES LC
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | G3500 FLUSHING RD STE 244
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City | FLINT
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State | MI
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Zip | 48504-4257
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Country | US
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Telephone | 813-943-5323
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Fax |
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Provider Business Mailing Address
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Address Line | 511 HICKORY HALL LN
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City | GOOSE CREEK
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State | SC
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Zip | 29445-6348
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Country | US
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Telephone | 813-943-5323
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. SEON F THOMPSON
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Credential | LICSW, BCD
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Telephone | 813-943-5323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 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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