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Organization
LIFE RECREATED PLLC
Active
Organization
LIFE RECREATED PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA QUEEN (BUSINESS MANAGER)
(704) 975-0691
Entity
Organization
Contact information
Practice address
825 3RD AVE NW STE 2, HICKORY, NC 28601-4806
(704) 975-0691
Mailing address
825 3RD AVE NW STE 2, HICKORY, NC 28601-4806
(704) 975-0691
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
—
NULL
106H00000X
Marriage & Family Therapist
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
Other
Enumeration date
06/19/2023
Last updated
06/21/2023
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