| New Life Counseling Services, Llc | |
|
1099 S Broadway Ste. 260, 160, And 280 Lexington KY 40504-2663 | |
| (859) 309-2384 | |
| (859) 406-1066 |
| Full Name | New Life Counseling Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 1099 S Broadway, Lexington, Kentucky |
| Authorized Official Name and Position | Dominique Lashan Wilson (CEO) |
| Authorized Official Contact | 8593683160 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Life Counseling Services, Llc 585 Southpoint Dr Lexington KY 40515-5121 Ph: (859) 368-3160 | New Life Counseling Services, Llc 1099 S Broadway Ste. 260, 160, And 280 Lexington KY 40504-2663 Ph: (859) 309-2384 |
| NPI Number | 1407263601 |
|---|---|
| Provider Enumeration Date | 07/20/2014 |
| Last Update Date | 09/03/2015 |
| Medicare PECOS PAC ID | 1557782133 |
|---|---|
| Medicare Enrollment ID | O20200608001062 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407263601 | NPI | - | NPPES |
| 7100266640 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | KY-1444 (Kentucky) | Primary |
| Provider Name | Alicia Alvarado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720622715 PECOS PAC ID: 6800226507 Enrollment ID: I20200421001110 |
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