Organization
THE LIFE CENTER COMPLEX, INC
Active
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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