Provider Demographics
NPI:1891290466
Name:YOUR BEST LIFE AWAITS COUNSELING & COACHING INSTITUTE, PLLC
Entity Type:Organization
Organization Name:YOUR BEST LIFE AWAITS COUNSELING & COACHING INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, ACSW, LCSW
Authorized Official - Phone:252-220-4140
Mailing Address - Street 1:107 SE MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27801-5400
Mailing Address - Country:US
Mailing Address - Phone:252-220-4140
Mailing Address - Fax:
Practice Address - Street 1:107 SE MAIN ST SUITE 203
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801
Practice Address - Country:US
Practice Address - Phone:252-220-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008788261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)