Healthcare Provider Details

I. General information

NPI: 1194959197
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ORANGE ST
ASHEVILLE NC
28801-2328
US

IV. Provider business mailing address

23 ORANGE ST
ASHEVILLE NC
28801-2328
US

V. Phone/Fax

Practice location:
  • Phone: 828-239-0156
  • Fax:
Mailing address:
  • Phone: 828-239-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HERB GRAY
Title or Position: OWNER
Credential:
Phone: 704-342-9595