Provider Demographics
NPI:1235803883
Name:LIFECARE COUNSELING LLC
Entity Type:Organization
Organization Name:LIFECARE COUNSELING LLC
Other - Org Name:LIFECARE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC, CCTP
Authorized Official - Phone:843-605-0514
Mailing Address - Street 1:1293 PROFESSIONAL DRIVE
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577
Mailing Address - Country:US
Mailing Address - Phone:843-213-1307
Mailing Address - Fax:843-962-5570
Practice Address - Street 1:1293 PROFESSIONAL DR STE A-101
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5754
Practice Address - Country:US
Practice Address - Phone:843-213-1307
Practice Address - Fax:843-962-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPG0661Medicaid