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General NPI Number Information
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NPI Number | 1346660057
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Entity Type | Organization
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Legal Business Name | A LIFE YOU LOVE LLC
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 577 NW 120TH DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-4029
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Country | US
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Telephone | 954-226-9671
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Fax |
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Provider Business Mailing Address
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Address Line | 577 NW 120TH DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-4029
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Country | US
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Telephone | 954-226-9671
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Fax |
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Authorized Official
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Title or Position | FOUNDER / THERAPIST
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Name | STACEY MEDNICK
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Credential | LCSW
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Telephone | 954-226-9671
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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 | SW10834
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License Number State | FL
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