Provider Demographics
NPI:1063164796
Name:LIFE COUNSELING AND HEALING, LLC
Entity type:Organization
Organization Name:LIFE COUNSELING AND HEALING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNERLTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-455-4323
Mailing Address - Street 1:472 NORWOOD ST FL 1
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1036
Mailing Address - Country:US
Mailing Address - Phone:201-455-4323
Mailing Address - Fax:
Practice Address - Street 1:214 BALDWIN TER FL 1
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-1805
Practice Address - Country:US
Practice Address - Phone:201-455-4323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health