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General NPI Number Information
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NPI Number | 1952531188
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Entity Type | Organization
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Legal Business Name | LIFE CHANGINGBEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 07/22/2009
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 817B S MADISON ST
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City | WHITEVILLE
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State | NC
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Zip | 28472-4613
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Country | US
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Telephone | 910-640-3008
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Fax | 910-640-3008
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Provider Business Mailing Address
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Address Line | 314 S MAIN ST
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City | FAIRMONT
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State | NC
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Zip | 28340-1906
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Country | US
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Telephone | 910-628-9091
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Fax | 910-628-9093
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Authorized Official
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Title or Position | COO
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Name | MR. LUIS ROMAN
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Credential |
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Telephone | 910-770-2682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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