Provider Demographics
NPI:1194425413
Name:180 THERAPY LIFE COACHING & CONSULTING, LLC
Entity type:Organization
Organization Name:180 THERAPY LIFE COACHING & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHUKAIRO
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS, RN
Authorized Official - Phone:980-309-8508
Mailing Address - Street 1:2431 ENCHANTO RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-9795
Mailing Address - Country:US
Mailing Address - Phone:980-309-8508
Mailing Address - Fax:
Practice Address - Street 1:331 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5383
Practice Address - Country:US
Practice Address - Phone:803-708-7556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health