Provider Demographics
NPI:1982471108
Name:LIVE INSPIRED COUNSELING & SUPPORT
Entity Type:Organization
Organization Name:LIVE INSPIRED COUNSELING & SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TECSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-598-5532
Mailing Address - Street 1:4908 SPRINT CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6126
Mailing Address - Country:US
Mailing Address - Phone:408-598-5532
Mailing Address - Fax:
Practice Address - Street 1:4908 SPRINT CIR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6126
Practice Address - Country:US
Practice Address - Phone:321-294-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty