Provider Demographics
NPI:1356006118
Name:FULL LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:FULL LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:AUGUSTONOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-476-5511
Mailing Address - Street 1:110 HAVERHILL ROAD
Mailing Address - Street 2:SUITE 518
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2121
Mailing Address - Country:US
Mailing Address - Phone:978-476-5511
Mailing Address - Fax:
Practice Address - Street 1:110 HAVERHILL RD STE 518
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2121
Practice Address - Country:US
Practice Address - Phone:978-476-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health