Healthcare Provider Details

I. General information

NPI: 1295399079
Provider Name (Legal Business Name): LIFE BEYOND THE SHADOWS COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 HERMITAGE ROAD
NEWPORT NEWS VA
23606-1449
US

IV. Provider business mailing address

144 HERMITAGE ROAD
NEWPORT NEWS VA
23606-1449
US

V. Phone/Fax

Practice location:
  • Phone: 335-524-5623
  • Fax: 336-458-4707
Mailing address:
  • Phone: 336-524-5623
  • Fax: 336-458-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER LYNN HAMBRIGHT
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 336-524-5623