=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659820140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSPIRED LIFE, COUNSELING AND COACHING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2016
-----------------------------------------------------
Last Update Date | 03/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1035 S STATE ROAD 7 SUITE 315
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-6134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-797-6187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12702 GUILFORD CIR
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-5505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-797-6187
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHOTHERAPIST
-----------------------------------------------------
Name | MRS. CHRISTINA ELIZABETH SAWYER
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 561-797-6187
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW 12681
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------