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General NPI Number Information
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NPI Number | 1558096701
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Entity Type | Organization
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Legal Business Name | LIFES CHANGES CENTER FOR WELLNESS
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2425 S LINDEN RD STE D138
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City | FLINT
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State | MI
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Zip | 48532-5482
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Country | US
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Telephone | 810-252-7994
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Fax |
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Provider Business Mailing Address
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Address Line | G3100 MILLER RD APT 19C
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City | FLINT
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State | MI
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Zip | 48507-1323
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Country | US
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Telephone | 810-252-7994
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES TODD KENNEDY
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Credential | LMSW
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Telephone | 810-252-7994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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