=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356765077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRATEGIES FOR LIFE COUNSELING, COACHING AND CONSULTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2014
-----------------------------------------------------
Last Update Date | 02/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 JEFFERY LN NE
-----------------------------------------------------
City | CARTERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30121-5061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-722-7040
-----------------------------------------------------
Fax | 877-519-8007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 JEFFERY LN NE
-----------------------------------------------------
City | CARTERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30121-5061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-722-7040
-----------------------------------------------------
Fax | 877-519-8007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | NENA RYBARCZYK
-----------------------------------------------------
Credential | MA, MBA, LPC, NCC
-----------------------------------------------------
Telephone | 770-722-7040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------