Provider Demographics
NPI:1376366153
Name:FULL OF LIFE COUNSELING AND ADDICTION SERVICES, PLLC
Entity type:Organization
Organization Name:FULL OF LIFE COUNSELING AND ADDICTION SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEVONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES WORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:336-829-4277
Mailing Address - Street 1:5166 FARM HOUSE TRL
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 CENTERPOINT DR STE 2200
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-7570
Practice Address - Country:US
Practice Address - Phone:336-829-4277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty