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General NPI Number Information
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NPI Number | 1972689081
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Entity Type | Organization
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Legal Business Name | THE LIFE COUNSELING CENTER, PA
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 124 LIFE WAY
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City | CLYDE
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State | NC
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Zip | 28721-6540
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Country | US
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Telephone | 828-627-5433
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Fax | 828-627-8888
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Provider Business Mailing Address
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Address Line | 247 MULLIGAN DRIVE
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City | CLYDE
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State | NC
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Zip | 28721-4401
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Country | US
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Telephone | 828-593-7926
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Fax | 828-627-8888
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Authorized Official
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Title or Position | OWNER/CEO
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Name | JAMES DOUGLAS MARKS
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Credential | LMFT
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Telephone | 828-283-3872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MHL-044-042
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License Number State | NC
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