Provider Demographics
NPI:1477727295
Name:CENTER FOR LIFE TRANSITIONS, PA
Entity Type:Organization
Organization Name:CENTER FOR LIFE TRANSITIONS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:239-549-8342
Mailing Address - Street 1:1505 SE 40TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-7913
Mailing Address - Country:US
Mailing Address - Phone:239-549-8342
Mailing Address - Fax:
Practice Address - Street 1:1505 SE 40TH ST STE E
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-7913
Practice Address - Country:US
Practice Address - Phone:239-549-8342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty