Provider Demographics
NPI:1205985066
Name:TOTAL LIFE COUNSELING, INC.
Entity type:Organization
Organization Name:TOTAL LIFE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO & OWNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:MA EDS / LPL
Authorized Official - Phone:540-989-1383
Mailing Address - Street 1:5401 FALLOWATER LN
Mailing Address - Street 2:SUITE C.
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0949
Mailing Address - Country:US
Mailing Address - Phone:540-989-1383
Mailing Address - Fax:540-989-8092
Practice Address - Street 1:5401 FALLOWATER LN
Practice Address - Street 2:SUITE C
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0949
Practice Address - Country:US
Practice Address - Phone:540-989-1383
Practice Address - Fax:540-989-8092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA025-02-019283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital