Provider Demographics
NPI:1346869682
Name:2020 LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:2020 LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANYCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA, LISW-S
Authorized Official - Phone:216-202-4528
Mailing Address - Street 1:6303 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2325
Mailing Address - Country:US
Mailing Address - Phone:216-832-2366
Mailing Address - Fax:
Practice Address - Street 1:21724 LORAIN RD STE 8
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3334
Practice Address - Country:US
Practice Address - Phone:216-202-4528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0353151Medicaid