Provider Demographics
NPI:1518114503
Name:COMPOSED LIFE SERVICES, PLLC
Entity Type:Organization
Organization Name:COMPOSED LIFE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:READ
Authorized Official - Last Name:PLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-286-3060
Mailing Address - Street 1:810 IREDELL ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4120
Mailing Address - Country:US
Mailing Address - Phone:919-286-3060
Mailing Address - Fax:919-416-3711
Practice Address - Street 1:810 IREDELL ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4120
Practice Address - Country:US
Practice Address - Phone:919-286-3060
Practice Address - Fax:919-416-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0028041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1649314105OtherNPI FOR MARIAN R. PLACE, LCSW AS AN INDIVIDUAL