1205985066 NPI number — TOTAL LIFE COUNSELING, INC.

Table of content: (NPI 1205985066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205985066 NPI number — TOTAL LIFE COUNSELING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL LIFE COUNSELING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205985066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 FALLOWATER LN
Provider Second Line Business Mailing Address:
SUITE C.
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24018-0949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-989-1383
Provider Business Mailing Address Fax Number:
540-989-8092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 FALLOWATER LN
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24018-0949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-989-1383
Provider Business Practice Location Address Fax Number:
540-989-8092
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCURDY
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDENT / CEO & OWNDER
Authorized Official Telephone Number:
540-989-1383

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  025-02-019 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com