Provider Demographics
NPI:1396016291
Name:INTEGRITY LIFE COACHING & PROFESSIONAL COUNSELING, LLC.
Entity type:Organization
Organization Name:INTEGRITY LIFE COACHING & PROFESSIONAL COUNSELING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:CRC, LCAS, LPC, CCS
Authorized Official - Phone:252-327-1014
Mailing Address - Street 1:PO BOX 8485
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8485
Mailing Address - Country:US
Mailing Address - Phone:252-327-1014
Mailing Address - Fax:
Practice Address - Street 1:2231 NASH ST NW
Practice Address - Street 2:SUITE B
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1712
Practice Address - Country:US
Practice Address - Phone:252-327-1014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC5318S251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health