Provider Demographics
NPI:1215504519
Name:GRATEFUL LIFE COUNSELING PLLC
Entity type:Organization
Organization Name:GRATEFUL LIFE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:COBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA
Authorized Official - Phone:336-430-7882
Mailing Address - Street 1:1604 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-3518
Mailing Address - Country:US
Mailing Address - Phone:336-430-7882
Mailing Address - Fax:
Practice Address - Street 1:1604 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-3518
Practice Address - Country:US
Practice Address - Phone:336-430-7882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty