Provider Demographics
NPI:1700310828
Name:MY LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:MY LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOTTA
Authorized Official - Middle Name:MONQIUE
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC CADC
Authorized Official - Phone:586-580-4243
Mailing Address - Street 1:13854 LAKESIDE CIR STE 245
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1316
Mailing Address - Country:US
Mailing Address - Phone:586-580-4243
Mailing Address - Fax:
Practice Address - Street 1:13854 LAKESIDE CIR STE 245
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1316
Practice Address - Country:US
Practice Address - Phone:586-580-4243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011148251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health