Organization
LIFE 360 THERAPY SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA AMBER CROWE RUSSELL M.S. CCC-SLP (PRESIDENT)
(910) 206-8228
Entity
Organization
Contact information
Practice address
13721 HERITAGE DR, LAURINBURG, NC 28352-9185
(910) 206-8228
Mailing address
13721 HERITAGE DR, LAURINBURG, NC 28352-9185
(910) 206-8228
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7173
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285893354
—
NC
Enumeration date
10/30/2015
Last updated
10/30/2015
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