Provider Demographics
NPI:1477983468
Name:LIFE SPRING COUNSELING AND CONSULTATION SERVICES LLC
Entity Type:Organization
Organization Name:LIFE SPRING COUNSELING AND CONSULTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ARLEEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-356-3271
Mailing Address - Street 1:6490 LANDOVER RD STE I
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1443
Mailing Address - Country:US
Mailing Address - Phone:301-356-3271
Mailing Address - Fax:
Practice Address - Street 1:6490 LANDOVER RD STE I
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1443
Practice Address - Country:US
Practice Address - Phone:301-356-3271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization