Provider Demographics
NPI:1407467434
Name:LIFE CHANGES COUNSELING AND CONSULTANT SERVICES, LLC
Entity Type:Organization
Organization Name:LIFE CHANGES COUNSELING AND CONSULTANT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MAC
Authorized Official - Phone:609-743-1773
Mailing Address - Street 1:1003 VIRGINIA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1366
Mailing Address - Country:US
Mailing Address - Phone:404-500-1994
Mailing Address - Fax:
Practice Address - Street 1:1003 VIRGINIA AVE STE 104
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1366
Practice Address - Country:US
Practice Address - Phone:404-500-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management