| Organization Name: | LIFE STAGES COUNSELING CENTER, INC |
| NPI Number: | 1114042652 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERESA GRELLA HILLEBRAND (LICENSED FAMILY THERAPIST/PARTNER) |
| Mailing Address: | 14 Candlewood Path Dix Hills |
| State: | NY US |
| Postal Code: | 117465304 |
| Phone Number: | 5166172635 |
| Fax Number: | 6314626499 |
| NPI Enumeration Date: | 03/21/2007 |
| NPI Last Update Date: | 06/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 6464 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |