Provider Demographics
NPI:1093078958
Name:LIFE COUNSELING AND DUI SCHOOL SERVICES
Entity Type:Organization
Organization Name:LIFE COUNSELING AND DUI SCHOOL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:TIRRELL
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD; LMFT
Authorized Official - Phone:229-412-2101
Mailing Address - Street 1:3720 BERMUDA RUN DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1060
Mailing Address - Country:US
Mailing Address - Phone:229-412-2101
Mailing Address - Fax:
Practice Address - Street 1:3720 BERMUDA RUN DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1060
Practice Address - Country:US
Practice Address - Phone:229-412-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health