Provider Demographics
NPI:1215567284
Name:LIFE ENHANCEMENT SPECIALIST LLC
Entity Type:Organization
Organization Name:LIFE ENHANCEMENT SPECIALIST LLC
Other - Org Name:PIONEER LIFE ENHANCEMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ADEELAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CATHCART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-447-8509
Mailing Address - Street 1:805 N CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3705
Mailing Address - Country:US
Mailing Address - Phone:443-447-8509
Mailing Address - Fax:
Practice Address - Street 1:805 N CALVERT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3705
Practice Address - Country:US
Practice Address - Phone:443-447-8509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-18
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty