Provider Demographics
NPI: | 1891223004 |
---|---|
Name: | TRUE LIFE COUNSELING, PLLC |
Entity type: | Organization |
Organization Name: | TRUE LIFE COUNSELING, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COUNSELOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NASHED |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 201-892-4308 |
Mailing Address - Street 1: | 1721 WILLOW BROOK CT |
Mailing Address - Street 2: | |
Mailing Address - City: | MEBANE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27302-8366 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 201-892-4308 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1721 WILLOW BROOK CT |
Practice Address - Street 2: | |
Practice Address - City: | MEBANE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27302-8366 |
Practice Address - Country: | US |
Practice Address - Phone: | 201-892-4308 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-06-01 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 12387 | 103TC1900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Single Specialty |