Organization
THE LIFE CENTER COMPLEX, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FORREST WATSON III MBA (PRESIDENT)
(302) 552-3574
Entity
Organization
Contact information
Practice address
1624 JESSUP ST, WILMINGTON, DE 19802-4210
(302) 552-3574
(302) 552-3561
Mailing address
812 PHILADELPHIA PIKE STE F, WILMINGTON, DE 19809-2371
(302) 407-5316
(302) 552-3561
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
71788
DE
261QC1500X
Community Health Clinic/Center
Primary
—
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770808578
—
DE
Enumeration date
04/05/2010
Last updated
03/28/2024
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