Provider Demographics
NPI:1598410359
Name:EMOTIONS 4LIFE
Entity Type:Organization
Organization Name:EMOTIONS 4LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-623-4305
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-0181
Mailing Address - Country:US
Mailing Address - Phone:843-623-4305
Mailing Address - Fax:
Practice Address - Street 1:4210 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:SC
Practice Address - Zip Code:29596-8814
Practice Address - Country:US
Practice Address - Phone:843-623-4305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty