Provider Demographics
NPI:1023402823
Name:LIFETIME COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:LIFETIME COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:EVON
Authorized Official - Last Name:TAYBRON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCS, NBCC
Authorized Official - Phone:910-864-0390
Mailing Address - Street 1:916 ARSENAL AVE
Mailing Address - Street 2:B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5328
Mailing Address - Country:US
Mailing Address - Phone:910-864-0390
Mailing Address - Fax:910-864-0396
Practice Address - Street 1:916 ARSENAL AVE
Practice Address - Street 2:B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5328
Practice Address - Country:US
Practice Address - Phone:910-864-0390
Practice Address - Fax:910-864-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS2018251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103617Medicaid