Provider Demographics
NPI:1720391295
Name:LIFE CENTERS USA COUNSELING
Entity Type:Organization
Organization Name:LIFE CENTERS USA COUNSELING
Other - Org Name:LIFE CENTERS USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDRON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-669-6133
Mailing Address - Street 1:19 WILBUR ST
Mailing Address - Street 2:
Mailing Address - City:COLONIE
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4555
Mailing Address - Country:US
Mailing Address - Phone:518-669-6133
Mailing Address - Fax:518-869-2122
Practice Address - Street 1:1524 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-5065
Practice Address - Country:US
Practice Address - Phone:518-669-6133
Practice Address - Fax:518-869-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19061101YA0400X
CA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty