Organization
LIFE CHANGING BEHAVIORAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LUIS ROMAN (COO)
(910) 770-2682
Entity
Organization
Contact information
Practice address
314 S MAIN ST, FAIRMONT, NC 28340-1906
(910) 628-6476
(910) 628-6531
Mailing address
314 S MAIN ST, FAIRMONT, NC 28340-1906
(910) 628-6476
(910) 628-6531
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
Other
Enumeration date
06/25/2010
Last updated
06/25/2010
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