MEDICARE: UPLIFTING LIVES AND SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1093568693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLIFTING LIVES AND SERVICES LLC

Provider Business Mailing Address
First Line	:	6601 IRONGATE SQ STE D
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6077
Country	:	US
Telephone Number	:	804-901-1842
Fax Number	:	804-942-0600

Provider Business Practice Location Address
First Line	:	6601 IRONGATE SQ STE D
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6077
Country	:	US
Telephone Number	:	804-901-1842
Fax Number	:	804-942-0600

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MS. SASHA B JOHNSON
Credential	:	LPC-S
Telephone Number	:	804-901-1842

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	10/16/2024

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