Provider Demographics
NPI:1669111589
Name:SUCCESS LIFE SKILLS SERVICES
Entity type:Organization
Organization Name:SUCCESS LIFE SKILLS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/LIFE COACH
Authorized Official - Prefix:MS
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. JUSTE
Authorized Official - Suffix:I
Authorized Official - Credentials:MHC
Authorized Official - Phone:973-370-2939
Mailing Address - Street 1:140 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2005
Mailing Address - Country:US
Mailing Address - Phone:973-370-2939
Mailing Address - Fax:
Practice Address - Street 1:140 N 26TH ST
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-2005
Practice Address - Country:US
Practice Address - Phone:973-370-2939
Practice Address - Fax:631-643-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health