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General NPI Number Information
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NPI Number | 1407265705
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Entity Type | Organization
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Legal Business Name | LIFE CHANGING CHRISTIAN COUNSELING
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 721 ROUTE 34 FL 2
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City | MATAWAN
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State | NJ
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Zip | 07747-6612
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Country | US
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Telephone | 732-858-4030
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Fax |
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Provider Business Mailing Address
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Address Line | 721 ROUTE 34 2ND FL
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City | MATAWAN
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State | NJ
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Zip | 07747
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Country | US
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Telephone | 732-858-4030
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LOIS GROSVENOR
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Credential | PH.D.
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Telephone | 732-939-6396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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