Provider Demographics
NPI:1205232220
Name:LIFE CHANGES INC
Entity Type:Organization
Organization Name:LIFE CHANGES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:336-387-0393
Mailing Address - Street 1:204 MUIRS CHAPEL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-6173
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 MUIRS CHAPEL RD
Practice Address - Street 2:STE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6173
Practice Address - Country:US
Practice Address - Phone:336-387-0393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty