Provider Demographics
NPI:1851579734
Name:LIFE SPAN COUNSELING CENTER PC
Entity Type:Organization
Organization Name:LIFE SPAN COUNSELING CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:HOLT
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, CNS
Authorized Official - Phone:919-777-6786
Mailing Address - Street 1:133 S HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4263
Mailing Address - Country:US
Mailing Address - Phone:910-777-6786
Mailing Address - Fax:910-777-6786
Practice Address - Street 1:133 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4263
Practice Address - Country:US
Practice Address - Phone:910-777-6786
Practice Address - Fax:910-777-6786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty