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Organization
LIFE ENRICHMENT SERVICES CENTER
Active
Organization
LIFE ENRICHMENT SERVICES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAZEL WILSON LCSW (OWNER)
(910) 422-3100
Entity
Organization
Contact information
Practice address
208 S BOND STREET, ROWLAND, NC 28383
(910) 422-3100
Mailing address
PO BOX 1085, ROWLAND, NC 28383-1085
(910) 422-3100
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C006810
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6007592
—
NC
Enumeration date
06/13/2012
Last updated
06/13/2012
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