Provider Demographics
NPI:1124471412
Name:LIFEWORKS COUNSELING
Entity type:Organization
Organization Name:LIFEWORKS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/ FAMILY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROANE
Authorized Official - Middle Name:THERELL
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-790-0583
Mailing Address - Street 1:818 BEAUMONT DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7310
Mailing Address - Country:US
Mailing Address - Phone:601-790-0583
Mailing Address - Fax:
Practice Address - Street 1:940 EBENEZER BLVD.
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-790-0583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1830251S00000X
MS1897251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty