Provider Demographics
NPI:1932797024
Name:360 LIFE SOLUTIONS
Entity type:Organization
Organization Name:360 LIFE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:330-509-0957
Mailing Address - Street 1:6375 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1919
Mailing Address - Country:US
Mailing Address - Phone:330-509-0957
Mailing Address - Fax:
Practice Address - Street 1:6375 BALSAM DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1919
Practice Address - Country:US
Practice Address - Phone:330-509-0957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty