Provider Demographics
NPI:1104336296
Name:NEWNESS OF LIFE COUNSELING LLC
Entity type:Organization
Organization Name:NEWNESS OF LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LESTER-BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LSW
Authorized Official - Phone:419-280-5890
Mailing Address - Street 1:5447 COUNTY ROAD 4
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9716
Mailing Address - Country:US
Mailing Address - Phone:419-280-5890
Mailing Address - Fax:
Practice Address - Street 1:7445 AIRPORT HWY STE E
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9544
Practice Address - Country:US
Practice Address - Phone:419-280-5890
Practice Address - Fax:419-280-5890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700263251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health