# LIFE RECREATED PLLC

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

## Provider details

- **NPI number:** 1154006104
- **Authorized official:** AMANDA QUEEN (BUSINESS MANAGER)
- **Authorized official phone:** (704) 975-0691

## Contact information

- **Practice address:** 825 3RD AVE NW STE 2, HICKORY, NC 28601-4806
- **Practice address phone:** (704) 975-0691
- **Mailing address:** 825 3RD AVE NW STE 2, HICKORY, NC 28601-4806
- **Mailing address phone:** (704) 975-0691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |
| 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