Provider Demographics
NPI: | 1013013473 |
---|---|
Name: | LIFE ENRICHMENT COUNSELING CENTER INC |
Entity Type: | Organization |
Organization Name: | LIFE ENRICHMENT COUNSELING CENTER INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | GAYLE |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | JOURDAIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 843-761-7446 |
Mailing Address - Street 1: | 130 LAND O PINES CIRCLE |
Mailing Address - Street 2: | |
Mailing Address - City: | MONCKS CORNER |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29461 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 843-761-7446 |
Mailing Address - Fax: | 843-761-7446 |
Practice Address - Street 1: | 130 LAND O PINES CIRCLE |
Practice Address - Street 2: | |
Practice Address - City: | MONCKS CORNER |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29461 |
Practice Address - Country: | US |
Practice Address - Phone: | 843-761-7446 |
Practice Address - Fax: | 843-761-7446 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-15 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |