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General NPI Number Information
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NPI Number | 1578912028
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Entity Type | Organization
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Legal Business Name | JOURNEYS OF LIFE THERAPEUTIC RESOURCES,LLC
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 2025 EBENEZER RD STE G
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City | ROCK HILL
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State | SC
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Zip | 29732-1069
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Country | US
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Telephone | 704-773-9003
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Fax |
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Provider Business Mailing Address
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Address Line | 7043 RED BUD CIR
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City | CHARLOTTE
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State | NC
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Zip | 28214-9324
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Country | US
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Telephone | 704-773-9003
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISTY BROWN PEARSON
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Credential | LPC
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Telephone | 704-773-9003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8236
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5788
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License Number State | SC
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