Provider Demographics
NPI:1639386105
Name:L.I.F.E. COUNSELING SERVICES
Entity Type:Organization
Organization Name:L.I.F.E. COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:THOMPSON-LISIECKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-283-6612
Mailing Address - Street 1:710 BOWERY LANE
Mailing Address - Street 2:BUILDING G BOX 41
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537
Mailing Address - Country:US
Mailing Address - Phone:912-496-2616
Mailing Address - Fax:912-496-2671
Practice Address - Street 1:710 BOWERY LN
Practice Address - Street 2:BUILDING G BOX 41
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-5967
Practice Address - Country:US
Practice Address - Phone:912-496-2616
Practice Address - Fax:912-496-2671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004677101YM0800X
GALPC003397101YM0800X
GAMEDIATION 2402104100000X
GAMSW0035901041C0700X
GALCSW0029611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty