Provider Demographics
NPI:1164891149
Name:LIFE WELLNESS COUNSELING PLLC
Entity Type:Organization
Organization Name:LIFE WELLNESS COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:BANE
Authorized Official - Last Name:SENERES
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:252-619-5451
Mailing Address - Street 1:126 RACQUET LN
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-7626
Mailing Address - Country:US
Mailing Address - Phone:252-619-5451
Mailing Address - Fax:910-725-0289
Practice Address - Street 1:100 PAVILION WAY STE E
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4560
Practice Address - Country:US
Practice Address - Phone:910-638-6748
Practice Address - Fax:910-725-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-19
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518215987Medicaid