Provider Demographics
NPI:1598322513
Name:LIFELINE COUNSELING AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:LIFELINE COUNSELING AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHITTIM
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-869-8965
Mailing Address - Street 1:1212 N WASHINGTON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2401
Mailing Address - Country:US
Mailing Address - Phone:509-869-8965
Mailing Address - Fax:509-466-9061
Practice Address - Street 1:1212 N WASHINGTON ST STE 104
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2401
Practice Address - Country:US
Practice Address - Phone:509-869-8965
Practice Address - Fax:509-466-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60153514OtherSTATE LICENSE