Organization
LIFECHANGINGBEHAVIORALHEALTHSERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUIS ROMAN (COO)
(910) 770-2682
Entity
Organization
Contact information
Practice address
18 WHITEVILLE MINI MALL, WHITEVILLE, NC 28472-2105
(910) 914-0006
(910) 914-0008
Mailing address
314 S MAIN ST, FAIRMONT, NC 28340-1906
(910) 628-9091
(910) 628-9093
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/30/2009
Last updated
09/30/2009
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