Healthcare Provider Details

I. General information

NPI: 1972756138
Provider Name (Legal Business Name): LIFE FORCE HYPNOSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 11/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 POST RD SUITE 10
WARWICK RI
02886-1543
US

IV. Provider business mailing address

1845 POST RD SUITE 10
WARWICK RI
02886-1543
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-4685
  • Fax: 401-737-4685
Mailing address:
  • Phone: 401-737-4685
  • Fax: 401-737-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberLCDP00439
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberLCDP00439
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberLCDP00439
License Number StateRI

VIII. Authorized Official

Name: MR. LANCE CLARKE MCCORMACK
Title or Position: MEMBER
Credential: L.C.D.P.
Phone: 401-737-4685