Organization
NEW LIFE COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE LASHAN WILSON M.ED., LPCC (CEO)
(859) 368-3160
Entity
Organization
Contact information
Practice address
1099 S BROADWAY, STE. 260, 160, AND 280, LEXINGTON, KY 40504-2663
(859) 309-2384
(859) 406-1066
Mailing address
585 SOUTHPOINT DR, LEXINGTON, KY 40515-5121
(859) 368-3160
(859) 406-1066
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
KY-1444
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100266640
—
KY
Enumeration date
07/20/2014
Last updated
09/03/2015
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