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General NPI Number Information
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NPI Number | 1689874851
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Entity Type | Organization
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Legal Business Name | LIFE CHANGES COUNSELING SERVICES
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 668 WITHROW RD
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City | FOREST CITY
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State | NC
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Zip | 28043-9695
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Country | US
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Telephone | 828-286-4466
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Fax | 828-286-4450
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Provider Business Mailing Address
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Address Line | 3611 MOUNT HOLLY HUNTERSVILLE RD SUITE 344
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City | CHARLOTTE
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State | NC
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Zip | 28216-8636
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Country | US
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Telephone | 704-451-8550
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Fax | 828-286-4450
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Authorized Official
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Title or Position | CEO
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Name | MS. LOQUITA DAWN ROBERTS
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Credential | MSW, LCSW
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Telephone | 704-451-8550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | COO4782P
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License Number State | NC
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