Provider Demographics
NPI:1205203692
Name:NEWLIFE COUNSELING AND CONSULTATION, PLLC
Entity Type:Organization
Organization Name:NEWLIFE COUNSELING AND CONSULTATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYWARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:704-727-6297
Mailing Address - Street 1:17105 KENTON DR
Mailing Address - Street 2:SUITE 205C
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5653
Mailing Address - Country:US
Mailing Address - Phone:704-727-6297
Mailing Address - Fax:
Practice Address - Street 1:17105 KENTON DR
Practice Address - Street 2:SUITE 205C
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5653
Practice Address - Country:US
Practice Address - Phone:704-727-6297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0094191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty