Provider Demographics
NPI:1740582105
Name:LIFE'S JOURNEY COUNSELING AND MEDIATION CENTER, LLC
Entity Type:Organization
Organization Name:LIFE'S JOURNEY COUNSELING AND MEDIATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-935-5433
Mailing Address - Street 1:512 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2780
Mailing Address - Country:US
Mailing Address - Phone:870-935-5433
Mailing Address - Fax:870-933-8112
Practice Address - Street 1:512 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2780
Practice Address - Country:US
Practice Address - Phone:870-935-5433
Practice Address - Fax:870-933-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0909055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty