Provider Demographics
NPI:1407265705
Name:LIFE CHANGING CHRISTIAN COUNSELING
Entity Type:Organization
Organization Name:LIFE CHANGING CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSVENOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-939-6396
Mailing Address - Street 1:721 ROUTE 34 2ND FL
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747
Mailing Address - Country:US
Mailing Address - Phone:732-858-4030
Mailing Address - Fax:
Practice Address - Street 1:721 ROUTE 34 FL 2
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-6612
Practice Address - Country:US
Practice Address - Phone:732-858-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty