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Organization
NITA J CHILDERS
Active
Organization
NITA J CHILDERS
Active
Other names
NEW LIFE COUNSELING & ASSESSMENT CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN HODGE (PROVIDER REPRESENTATIVE)
(903) 984-7000
Entity
Organization
Contact information
Practice address
1100 STONE RD, SUITE 102, KILGORE, TX 75662-5482
(903) 984-7000
(903) 984-7001
Mailing address
PO BOX 3428, KILGORE, TX 75663-3428
(903) 984-7000
(903) 984-7001
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1990301
—
TX
Enumeration date
02/02/2009
Last updated
06/02/2009
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