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General NPI Number Information
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NPI Number | 1376894816
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Entity Type | Organization
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Legal Business Name | LIFESTYLE MANAGEMENT COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 2404 HUBBARD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-2911
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Country | US
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Telephone | 904-902-2454
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Fax | 888-474-2998
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Provider Business Mailing Address
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Address Line | 2404 HUBBARD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-2911
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Country | US
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Telephone | 904-902-2454
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Fax | 888-474-2998
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STEPHANIE MCELVEEN
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Credential | LCSW
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Telephone | 904-902-2454
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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 | CSW004714
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License Number State | GA
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