Organization
LIFE CHANGING BEHAVIRAL 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) 628-9091
(910) 628-9093
Mailing address
314 S MAIN ST, FAIRMONT, NC 28340-1906
(910) 628-9091
(910) 628-9093
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
104100000X
Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
07/23/2009
Last updated
06/18/2010
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