Provider Demographics
NPI:1457540700
Name:LIFE BASED CONCEPTIONS, LLC
Entity Type:Organization
Organization Name:LIFE BASED CONCEPTIONS, LLC
Other - Org Name:LBC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMMUNITY SUPPORT PROFESSIONAL
Authorized Official - Prefix:MR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:GILES
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:919-403-6160
Mailing Address - Street 1:2144 PAGE ROAD, STE 102
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2564
Mailing Address - Country:US
Mailing Address - Phone:919-403-6160
Mailing Address - Fax:919-640-8810
Practice Address - Street 1:2144 PAGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5952
Practice Address - Country:US
Practice Address - Phone:919-403-6160
Practice Address - Fax:919-640-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302408Medicaid
NC3418491Medicaid