Provider Demographics
NPI:1083338032
Name:LIFEPATH HOLISTIC COUNSELING AND CONSULTING, PLLC.
Entity Type:Organization
Organization Name:LIFEPATH HOLISTIC COUNSELING AND CONSULTING, PLLC.
Other - Org Name:LIFEPATH HOLISTIC COUNSELING AND CONSULTING, PLLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED CLINICAL MENTAL HEALTH COU
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:RENVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA, NCC
Authorized Official - Phone:704-899-1555
Mailing Address - Street 1:PO BOX 242363
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28224-2363
Mailing Address - Country:US
Mailing Address - Phone:704-899-1555
Mailing Address - Fax:
Practice Address - Street 1:104 WAXHAW PROFESSIONAL PARK DR STE D
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-5020
Practice Address - Country:US
Practice Address - Phone:704-899-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty