Healthcare Provider Details

I. General information

NPI: 1154288306
Provider Name (Legal Business Name): PURPOSED LIFE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FORBES BLVD STE 200
LANHAM MD
20706-6316
US

IV. Provider business mailing address

2714 PRINCESS VICTORIA WAY
MITCHELLVILLE MD
20721-2439
US

V. Phone/Fax

Practice location:
  • Phone: 201-341-0153
  • Fax:
Mailing address:
  • Phone: 201-341-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. TERRI FIELDS
Title or Position: ADMINISTRATIVE HC CONSULTANT
Credential: CPAT, CPC, CTLC, CS
Phone: 443-567-6120