Healthcare Provider Details

I. General information

NPI: 1720799117
Provider Name (Legal Business Name): LIFE NET SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 JEFFERSON ST STE 114
WHITEVILLE NC
28472-3702
US

IV. Provider business mailing address

PO BOX 87024
FAYETTEVILLE NC
28304-7024
US

V. Phone/Fax

Practice location:
  • Phone: 910-745-8895
  • Fax:
Mailing address:
  • Phone: 910-745-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ALICIA CABBAGESTALK
Title or Position: OWNER
Credential:
Phone: 910-745-8895