Provider Demographics
NPI:1568016111
Name:YOUR WAY LIFE COACHING & CONSULTING, LLC
Entity Type:Organization
Organization Name:YOUR WAY LIFE COACHING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBOMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA/HCM, CNLPMP, CBT
Authorized Official - Phone:980-643-4030
Mailing Address - Street 1:530 E INNES ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-5100
Mailing Address - Country:US
Mailing Address - Phone:980-643-4030
Mailing Address - Fax:
Practice Address - Street 1:530 E INNES ST STE 101
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5100
Practice Address - Country:US
Practice Address - Phone:980-643-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty