# LIFE MATRIX NC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134698509
- **Authorized official:** MRS. DEBRA M JOHNSON LCSW (CLINICAL DIRECTOR)
- **Authorized official phone:** (910) 797-7354

## Contact information

- **Practice address:** 100 HAY ST STE 701, FAYETTEVILLE, NC 28301-5487
- **Practice address phone:** (910) 444-1996
- **Practice address fax:** (800) 337-1933
- **Mailing address:** 100 HAY ST STE 701, FAYETTEVILLE, NC 28301-5487
- **Mailing address phone:** (910) 797-7354

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |
| 171400000X | Health & Wellness Coach | — | NULL | — |
| 171400000X | Health & Wellness Coach | — | — | — |

## Other

- **Enumeration date:** 11/15/2018
- **Last updated:** 10/03/2023