Provider Demographics
NPI:1275664831
Name:LIFE CHANGES COUNSELING LLC
Entity Type:Organization
Organization Name:LIFE CHANGES COUNSELING LLC
Other - Org Name:SUSAN FEEHAN, LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:FEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:478-397-6209
Mailing Address - Street 1:105 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9713
Mailing Address - Country:US
Mailing Address - Phone:478-397-6209
Mailing Address - Fax:478-922-1778
Practice Address - Street 1:121 CARL VINSON PKWY
Practice Address - Street 2:PSYCHOLOGICAL OFFICES
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5817
Practice Address - Country:US
Practice Address - Phone:478-922-2365
Practice Address - Fax:478-922-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1073577557OtherNPI UNDER SSN