Healthcare Provider Details

I. General information

NPI: 1588249593
Provider Name (Legal Business Name): NEW LIFE TRANSITIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 COMMERCE DR STE 315
HAMPTON VA
23666-4298
US

IV. Provider business mailing address

1919 COMMERCE DR STE 315
HAMPTON VA
23666-4298
US

V. Phone/Fax

Practice location:
  • Phone: 757-204-5469
  • Fax:
Mailing address:
  • Phone: 757-204-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANIKA HARRIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 757-575-5535