Healthcare Provider Details

I. General information

NPI: 1427743921
Provider Name (Legal Business Name): URBAN LIFE COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 COLLEY AVE
NORFOLK VA
23508-2166
US

IV. Provider business mailing address

5215 COLLEY AVE
NORFOLK VA
23508-2166
US

V. Phone/Fax

Practice location:
  • Phone: 757-945-7527
  • Fax: 757-956-1915
Mailing address:
  • Phone: 757-945-7527
  • Fax: 757-956-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAKIYA TAYLOR
Title or Position: LICENSED CLINICIAN
Credential: LPC, LSATP
Phone: 757-753-1130