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General NPI Number Information
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NPI Number | 1639386105
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Entity Type | Organization
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Legal Business Name | L.I.F.E. COUNSELING SERVICES
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 710 BOWERY LN BUILDING G BOX 41
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City | FOLKSTON
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State | GA
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Zip | 31537-5967
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Country | US
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Telephone | 912-496-2616
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Fax | 912-496-2671
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Provider Business Mailing Address
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Address Line | 710 BOWERY LANE BUILDING G BOX 41
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City | FOLKSTON
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State | GA
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Zip | 31537
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Country | US
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Telephone | 912-496-2616
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Fax | 912-496-2671
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DONNA KAY THOMPSON-LISIECKI
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Credential | LPC
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Telephone | 912-283-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC003397
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MEDIATION 2402
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | MSW003590
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW002961
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC004677
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License Number State | GA
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