Provider Demographics
NPI:1285075549
Name:LIFE GUIDANCE ASSOCIATES
Entity type:Organization
Organization Name:LIFE GUIDANCE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:484-527-0181
Mailing Address - Street 1:43 LEOPARD RD
Mailing Address - Street 2:BUILDING 2, SUITE 203
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:43 LEOPARD RD
Practice Address - Street 2:BUILDING 2, SUITE 203
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1552
Practice Address - Country:US
Practice Address - Phone:484-257-0181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty