Provider Demographics
NPI:1164882759
Name:CYCLE OF LIFE COUNSELING, PLLC
Entity Type:Organization
Organization Name:CYCLE OF LIFE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEVORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-412-8360
Mailing Address - Street 1:15720 BRIXHAM HILL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4784
Mailing Address - Country:US
Mailing Address - Phone:704-412-8360
Mailing Address - Fax:704-603-3006
Practice Address - Street 1:15720 BRIXHAM HILL AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4784
Practice Address - Country:US
Practice Address - Phone:704-412-8360
Practice Address - Fax:704-603-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty