Provider Demographics
NPI:1174077382
Name:LIFE CHANGING THERAPEUTIC SOLUTIONS, LLC
Entity type:Organization
Organization Name:LIFE CHANGING THERAPEUTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-368-9485
Mailing Address - Street 1:25 WOODS LAKE RD
Mailing Address - Street 2:STE 712
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6125
Mailing Address - Country:US
Mailing Address - Phone:864-606-3528
Mailing Address - Fax:
Practice Address - Street 1:25 WOODS LAKE RD
Practice Address - Street 2:STE 712
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6125
Practice Address - Country:US
Practice Address - Phone:864-606-3528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health