Organization
LIFE EXTENSIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STELLA L GREEN LCSW LCAS CSI SAP (OWNER)
(919) 532-9855
Entity
Organization
Contact information
Practice address
2820 CALLIOPE WAY APT 103, RALEIGH, NC 27616-6060
(919) 532-9855
Mailing address
1003 DRESSER CT, RALEIGH, NC 27609-7323
(919) 532-9855
(919) 803-7231
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152868867
—
NC
05
—
1790042356
—
NC
Enumeration date
04/19/2020
Last updated
12/17/2024
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