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General NPI Number Information
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NPI Number | 1922248376
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Entity Type | Organization
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Legal Business Name | LIFESKILLS COUNSELING & CONSULTING GROUP
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 02/01/2010
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Provider Practice Location Address
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Address Line | 1973 JN PEASE PL SUITE 102
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City | CHARLOTTE
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State | NC
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Zip | 28262-4547
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Country | US
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Telephone | 704-548-5299
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Fax | 704-548-5292
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Provider Business Mailing Address
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Address Line | 1973 JN PEASE PL SUITE 102
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City | CHARLOTTE
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State | NC
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Zip | 28262-4547
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Country | US
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Telephone | 704-548-5299
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Fax | 704-548-5292
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LATONYA MICHELLE MASON
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Credential | MA LPC
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Telephone | 704-548-5299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4355
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License Number State | NC
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