Provider Demographics
NPI:1568762409
Name:THE LIFEWORKS GROUP, INC.
Entity Type:Organization
Organization Name:THE LIFEWORKS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC
Authorized Official - Phone:407-647-7005
Mailing Address - Street 1:1850 LEE RD
Mailing Address - Street 2:STE 250
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2116
Mailing Address - Country:US
Mailing Address - Phone:407-647-7005
Mailing Address - Fax:407-647-8874
Practice Address - Street 1:1850 LEE RD
Practice Address - Street 2:STE 250
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2116
Practice Address - Country:US
Practice Address - Phone:407-647-7005
Practice Address - Fax:407-647-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3247101Y00000X, 101YM0800X, 101YP2500X
FLMT876101Y00000X, 101YM0800X, 106H00000X
FLMH1568101Y00000X, 101YA0400X, 101YM0800X
FLMH7863101Y00000X, 101YM0800X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty