Provider Demographics
NPI:1437458791
Name:LIFEPATH, PLLC
Entity Type:Organization
Organization Name:LIFEPATH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-255-3367
Mailing Address - Street 1:2820 LAWNDALE DR STE 112
Mailing Address - Street 2:BOX 12
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4127
Mailing Address - Country:US
Mailing Address - Phone:336-542-5777
Mailing Address - Fax:336-542-5777
Practice Address - Street 1:2820 LAWNDALE DR STE 112
Practice Address - Street 2:BOX 12
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4127
Practice Address - Country:US
Practice Address - Phone:336-542-5777
Practice Address - Fax:336-542-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health