Provider Demographics
NPI:1215259874
Name:TRANSFORMATIVE LIFE CENTER, LLC.
Entity type:Organization
Organization Name:TRANSFORMATIVE LIFE CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LEDAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:980-406-4393
Mailing Address - Street 1:11600 NORTH COMMUNITY HOUSE ROAD
Mailing Address - Street 2:SUITE #125
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-1885
Mailing Address - Country:US
Mailing Address - Phone:704-927-5885
Mailing Address - Fax:
Practice Address - Street 1:3719 LATROBE DR
Practice Address - Street 2:SUITE #850
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4861
Practice Address - Country:US
Practice Address - Phone:704-927-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3909103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty