Healthcare Provider Details

I. General information

NPI: 1023900792
Provider Name (Legal Business Name): LIFE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N SECOND ST
MEBANE NC
27302-2401
US

IV. Provider business mailing address

301 N SECOND ST
MEBANE NC
27302-2401
US

V. Phone/Fax

Practice location:
  • Phone: 984-278-2722
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: OLUWATOSIN OLASUNKANMI
Title or Position: OWNER
Credential:
Phone: 984-278-2722