Healthcare Provider Details

I. General information

NPI: 1609746494
Provider Name (Legal Business Name): NEW LIFE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 FORT WADE RD STE 100-1028
PONTE VEDRA FL
32081-5146
US

IV. Provider business mailing address

PO BOX 2153
LAURINBURG NC
28353-2153
US

V. Phone/Fax

Practice location:
  • Phone: 910-506-4018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SMITH
Title or Position: CEO
Credential: MSW, LCSW, LCAS, CCS
Phone: 910-506-4018