Provider Demographics
NPI:1235562463
Name:LIFELINE PROFESSIONAL COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:LIFELINE PROFESSIONAL COUNSELING SERVICES, INC
Other - Org Name:ALPHA OMEGA PCCS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALPOS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:480-203-8414
Mailing Address - Street 1:5040 E SHEA BLVD
Mailing Address - Street 2:#164
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4600
Mailing Address - Country:US
Mailing Address - Phone:480-203-8414
Mailing Address - Fax:
Practice Address - Street 1:5040 E SHEA BLVD
Practice Address - Street 2:#164
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4600
Practice Address - Country:US
Practice Address - Phone:480-203-8414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC13318251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health