Provider Demographics
NPI:1700259926
Name:TRANSITIONS IN LYFE
Entity Type:Organization
Organization Name:TRANSITIONS IN LYFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-260-4904
Mailing Address - Street 1:173 FAIRMONT CIR
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-7819
Mailing Address - Country:US
Mailing Address - Phone:843-260-4904
Mailing Address - Fax:704-469-4714
Practice Address - Street 1:173 FAIRMONT CIR
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-7819
Practice Address - Country:US
Practice Address - Phone:843-260-4904
Practice Address - Fax:704-469-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health