Provider Demographics
NPI:1043757412
Name:LIFE SOLUTIONS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LIFE SOLUTIONS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISCENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAZZOCCHI
Authorized Official - Suffix:
Authorized Official - Credentials:EDM,NCC,LOC,ALPS
Authorized Official - Phone:304-688-9732
Mailing Address - Street 1:19 ROCK LICK RD
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-9749
Mailing Address - Country:US
Mailing Address - Phone:304-688-9732
Mailing Address - Fax:304-688-9732
Practice Address - Street 1:19 ROCK LICK RD
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-9749
Practice Address - Country:US
Practice Address - Phone:304-688-9732
Practice Address - Fax:304-688-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty