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General NPI Number Information
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NPI Number | 1710423041
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Entity Type | Organization
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Legal Business Name | LIFESPAN COUNSELING AT THE KIDS COUCH INC LLC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 5700 KIRKWOOD HWY SUITE 203
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City | WILMINGTON
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State | DE
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Zip | 19808-4857
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Country | US
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Telephone | 302-384-8222
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Fax | 302-407-6698
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Provider Business Mailing Address
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Address Line | 5700 KIRKWOOD HWY SUITE 203
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City | WILMINGTON
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State | DE
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Zip | 19808-4857
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Country | US
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Telephone | 302-384-8222
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Fax | 302-407-6698
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | OLGA YATZUS
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Credential | LPCMH
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Telephone | 302-384-8222
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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 | PC-0000362
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License Number State | DE
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