Healthcare Provider Details

I. General information

NPI: 1144634528
Provider Name (Legal Business Name): THE VILLAGE LIFE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58155 CHINN ST STE B
PLAQUEMINE LA
70764-3601
US

IV. Provider business mailing address

9660 FALLS OF NEUSE RD STE 138
RALEIGH NC
27615-2435
US

V. Phone/Fax

Practice location:
  • Phone: 225-385-4543
  • Fax: 866-825-9703
Mailing address:
  • Phone: 919-723-8799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AYANNA CARR
Title or Position: CEO
Credential:
Phone: 919-723-8799