=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437613056
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEAUTIFUL LIFE COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2019
-----------------------------------------------------
Last Update Date | 01/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1413 CALHOUN ST STE 140
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29201-2562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-727-5774
-----------------------------------------------------
Fax | 903-807-2561
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1413 CALHOUN ST STE 140
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29201-2562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-727-5774
-----------------------------------------------------
Fax | 903-807-2561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LPC
-----------------------------------------------------
Name | ALISA E WEESE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 803-727-5774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------