Provider Demographics
NPI:1750979332
Name:VIBRANT LIFE COUNSELING, PLLC
Entity type:Organization
Organization Name:VIBRANT LIFE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENA
Authorized Official - Middle Name:PERKINS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMCHA
Authorized Official - Phone:336-301-3426
Mailing Address - Street 1:6030 FORDING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6347
Mailing Address - Country:US
Mailing Address - Phone:336-301-3426
Mailing Address - Fax:
Practice Address - Street 1:1101 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1829
Practice Address - Country:US
Practice Address - Phone:336-270-9501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health