Provider Demographics
NPI:1174946057
Name:LIFE PREP COUNSELING
Entity type:Organization
Organization Name:LIFE PREP COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-497-8895
Mailing Address - Street 1:520 MAIN ST
Mailing Address - Street 2:UPPER LEVEL, SUITE 4
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-497-8895
Mailing Address - Fax:
Practice Address - Street 1:520 MAIN ST
Practice Address - Street 2:UPPER LEVEL, SUITE 4
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7420
Practice Address - Country:US
Practice Address - Phone:732-497-8895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00488300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty