Provider Demographics
NPI:1780884791
Name:LIFE SKILLS COUNSELING, PLLC
Entity type:Organization
Organization Name:LIFE SKILLS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-833-2544
Mailing Address - Street 1:204 N PERSON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1047
Mailing Address - Country:US
Mailing Address - Phone:919-833-2544
Mailing Address - Fax:919-833-0939
Practice Address - Street 1:721 TUCKER ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1248
Practice Address - Country:US
Practice Address - Phone:919-833-8862
Practice Address - Fax:919-833-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL092636251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300583Medicaid
NC8300583HMedicaid
NC8300583GMedicaid