Provider Demographics
NPI:1518509249
Name:ENGAGE IN LIFE, LLC
Entity Type:Organization
Organization Name:ENGAGE IN LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:252-455-9725
Mailing Address - Street 1:115 COOKE ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7545
Mailing Address - Country:US
Mailing Address - Phone:252-455-9725
Mailing Address - Fax:
Practice Address - Street 1:800 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1704
Practice Address - Country:US
Practice Address - Phone:252-455-9725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)