MEDICARE: LIFECARE COUNSELING AND COACHING, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YP1600X	Pastoral Counselor
3	1041C0700X	Clinical Social Worker
4	106H00000X	Marriage & Family Therapist		NC
5	101YP2500X	Professional Counselor	6654	NC

General Provider Information

NPI Number	:	1750539516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFECARE COUNSELING AND COACHING, INC

Provider Business Mailing Address
First Line	:	1601 JONES FRANKLIN RD
Second Line	:	SUITE 104
City	:	RALEIGH
State	:	NC
Zip	:	27606-3379
Country	:	US
Telephone Number	:	919-851-1527
Fax Number	:	919-851-3555

Provider Business Practice Location Address
First Line	:	1601 JONES FRANKLIN RD
Second Line	:	SUITE 104
City	:	RALEIGH
State	:	NC
Zip	:	27606-3379
Country	:	US
Telephone Number	:	919-851-1527
Fax Number	:	919-851-3555

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GERALD W LANKFORD
Credential	:	MACC, MBA, MDIV, LPC
Telephone Number	:	919-851-1527

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	11/21/2011

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