Healthcare Provider Details

I. General information

NPI: 1003748567
Provider Name (Legal Business Name): VISION INSPIRED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 CANON BLVD STE B108
NEWPORT NEWS VA
23606-2570
US

IV. Provider business mailing address

PO BOX 22413
NEWPORT NEWS VA
23609-2413
US

V. Phone/Fax

Practice location:
  • Phone: 757-509-5278
  • Fax:
Mailing address:
  • Phone: 757-509-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: ROSA MAE JOHNSON
Title or Position: FOUNDER
Credential: LPC
Phone: 757-790-7218