Provider Demographics
NPI:1134642754
Name:LIFECARE COUNSELING AND COACHING
Entity Type:Organization
Organization Name:LIFECARE COUNSELING AND COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LANKFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:276-415-0311
Mailing Address - Street 1:117 KINGSPORT RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9221
Mailing Address - Country:US
Mailing Address - Phone:919-753-3368
Mailing Address - Fax:
Practice Address - Street 1:280 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2749
Practice Address - Country:US
Practice Address - Phone:276-415-0311
Practice Address - Fax:276-335-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006875101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701006875OtherVIRGINIA BOARD OF COUNSELING