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General NPI Number Information
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NPI Number | 1831866581
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Entity Type | Organization
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Legal Business Name | SEASONS OF LIFE THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 08/29/2021
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Last Update Date | 08/29/2021
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Provider Practice Location Address
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Address Line | 8313 SIX FORKS RD STE 211
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City | RALEIGH
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State | NC
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Zip | 27615-5099
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Country | US
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Telephone | 919-270-5844
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Fax |
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Provider Business Mailing Address
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Address Line | 8313 SIX FORKS RD STE 211
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City | RALEIGH
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State | NC
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Zip | 27615-5099
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/LMFT
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Name | TONI ANN NICOLSEN
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Credential | LMFT
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Telephone | 919-270-5844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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