Healthcare Provider Details

I. General information

NPI: 1831464379
Provider Name (Legal Business Name): VALLEY CENTER FOR LIFE ENRICHMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JACKSON ST STE B
ROANOKE RAPIDS NC
27870-2646
US

IV. Provider business mailing address

600 JACKSON ST STE B
ROANOKE RAPIDS NC
27870-2646
US

V. Phone/Fax

Practice location:
  • Phone: 252-308-0744
  • Fax: 252-308-0092
Mailing address:
  • Phone: 252-676-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENNA CARPENTER
Title or Position: OWNER
Credential: LCMHCS
Phone: 252-676-6636