Organization
LIFE CHANGINGBEHAVIORAL 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
817B S MADISON ST, WHITEVILLE, NC 28472-4613
(910) 640-3008
(910) 640-3008
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
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006847
—
NC
Enumeration date
07/22/2009
Last updated
09/23/2011
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