Provider Demographics
NPI:1013753235
Name:LIFES PATH LLC
Entity type:Organization
Organization Name:LIFES PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:386-327-1519
Mailing Address - Street 1:101 N WOODLAND BLVD STE A306
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-4240
Mailing Address - Country:US
Mailing Address - Phone:386-327-1519
Mailing Address - Fax:
Practice Address - Street 1:101 N WOODLAND BLVD STE A306
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4240
Practice Address - Country:US
Practice Address - Phone:321-578-8479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty