Provider Demographics
NPI:1114042652
Name:LIFE STAGES COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:LIFE STAGES COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED FAMILY THERAPIST/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:GRELLA
Authorized Official - Last Name:HILLEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:516-617-2635
Mailing Address - Street 1:14 CANDLEWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5304
Mailing Address - Country:US
Mailing Address - Phone:516-617-2635
Mailing Address - Fax:631-462-6499
Practice Address - Street 1:14 CANDLEWOOD PATH
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5304
Practice Address - Country:US
Practice Address - Phone:516-617-2635
Practice Address - Fax:631-462-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6464101YA0400X
NY074243-11041C0700X
NY000155-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty