Provider Demographics
NPI:1346570199
Name:LIFEFORCE P.L.L.C.
Entity Type:Organization
Organization Name:LIFEFORCE P.L.L.C.
Other - Org Name:LIFEFORCE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STAJICH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CTC
Authorized Official - Phone:586-726-8622
Mailing Address - Street 1:15840 LAKESIDE VILLAGE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6135
Mailing Address - Country:US
Mailing Address - Phone:586-726-8622
Mailing Address - Fax:586-226-8542
Practice Address - Street 1:43599 SCHOENHERR STE 200C
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1177
Practice Address - Country:US
Practice Address - Phone:586-726-8622
Practice Address - Fax:586-226-8542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801077324251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health