180 Therapy Life Coaching & Consulting, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

180 THERAPY LIFE COACHING & CONSULTING, LLC

Doing business as

180 TLC

Practice address

331 E Main St
Rock Hill, SC 29730-5383

Phone

(803) 708-7556

NPI assigned

Mar 6, 2023

Last updated

Mar 6, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shukairo Mack Baker, LCSW, LCAS, RNNPI 1659666444

Title

Clinical Director

Phone

(980) 309-8508

Specialties & licenses 1

Addresses

Other names 1

• 180 TLC Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shukairo Mack Baker, APRN, PMHNP-BC, LCSW

  • Psychiatric/Mental Health Nurse Practitioner
  • Rock Hill, SC
  • NPI 1659666444
  NPD (past) Authorized official
• Casandra M. Surma

  • Counselor
  • Sanford, NC
  • NPI 1144523457
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1194425413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2431 ENCHANTO RD",
            "city": "YORK",
            "state": "SC",
            "postal_code": "297459795",
            "telephone_number": "980-309-8508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 E MAIN ST",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297305383",
            "telephone_number": "803-708-7556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "180 THERAPY LIFE COACHING & CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-06",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "SHUKAIRO",
        "authorized_official_middle_name": "MACK",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "980-309-8508",
        "authorized_official_credential": "LCSW, LCAS, RN"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "180 TLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Behavioral Health Agency in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Community/Behavioral Health Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.