Provider Demographics
NPI:1235525999
Name:TRANSFORMATIVE LIFE CENTRES, LLC.
Entity Type:Organization
Organization Name:TRANSFORMATIVE LIFE CENTRES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEDAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-708-4605
Mailing Address - Street 1:134 W MATTHEWS ST
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1305
Mailing Address - Country:US
Mailing Address - Phone:704-708-4605
Mailing Address - Fax:704-469-5807
Practice Address - Street 1:134 W MATTHEWS ST
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1305
Practice Address - Country:US
Practice Address - Phone:704-708-4605
Practice Address - Fax:704-469-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty