Provider Demographics
NPI:1104281617
Name:LIFE COACHING
Entity type:Organization
Organization Name:LIFE COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIFE COACH
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-260-5106
Mailing Address - Street 1:4449 ALDERNY CIR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9276
Mailing Address - Country:US
Mailing Address - Phone:919-260-5106
Mailing Address - Fax:
Practice Address - Street 1:1201 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-2354
Practice Address - Country:US
Practice Address - Phone:919-973-2799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty