Provider Demographics
NPI:1245773167
Name:LIFE PROVISIONS, LLC.
Entity Type:Organization
Organization Name:LIFE PROVISIONS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:DEMETRIA
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:704-300-4273
Mailing Address - Street 1:2025 EBENEZER RD STE J4
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1079
Mailing Address - Country:US
Mailing Address - Phone:704-300-4273
Mailing Address - Fax:
Practice Address - Street 1:2025 EBENEZER RD STE J4
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1079
Practice Address - Country:US
Practice Address - Phone:704-300-4273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-25
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty