Provider Demographics
NPI:1336635978
Name:WITHIN YOU LIFE SERVICES, PLLC
Entity type:Organization
Organization Name:WITHIN YOU LIFE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:336-558-8083
Mailing Address - Street 1:2714 RALPH JOHNS ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3999
Mailing Address - Country:US
Mailing Address - Phone:336-558-8083
Mailing Address - Fax:
Practice Address - Street 1:2714 RALPH JOHNS ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3999
Practice Address - Country:US
Practice Address - Phone:336-558-8083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty