Healthcare Provider Details

I. General information

NPI: 1124688536
Provider Name (Legal Business Name): HERE'S 2 LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6023 RIDDLE WALK
ALEXANDRIA VA
22312-2773
US

IV. Provider business mailing address

6023 RIDDLE WALK
ALEXANDRIA VA
22312-2773
US

V. Phone/Fax

Practice location:
  • Phone: 703-624-3459
  • Fax:
Mailing address:
  • Phone: 703-624-3459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIAN D. OWENS
Title or Position: CLINICAL/EXECUTIVE DIRECTOR
Credential: PHD, MPH
Phone: 703-624-3459