Provider Demographics
NPI:1841419652
Name:LIFELINE COUNSELING ASSOCIATES, INC
Entity Type:Organization
Organization Name:LIFELINE COUNSELING ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PAYNE
Authorized Official - Last Name:PETREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-257-9321
Mailing Address - Street 1:10305 MEMORY LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8815
Mailing Address - Country:US
Mailing Address - Phone:804-748-2000
Mailing Address - Fax:804-748-9098
Practice Address - Street 1:10305 MEMORY LN
Practice Address - Street 2:SUITE 202
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8815
Practice Address - Country:US
Practice Address - Phone:804-748-2000
Practice Address - Fax:804-748-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)