Provider Demographics
NPI:1912339979
Name:LIFE TALK COUNSELING, LLC
Entity Type:Organization
Organization Name:LIFE TALK COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, BCPC
Authorized Official - Phone:973-943-8826
Mailing Address - Street 1:483 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2904
Mailing Address - Country:US
Mailing Address - Phone:973-943-8826
Mailing Address - Fax:
Practice Address - Street 1:999 RIVERVIEW DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1164
Practice Address - Country:US
Practice Address - Phone:973-406-5310
Practice Address - Fax:973-406-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00422200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty