Healthcare Provider Details

I. General information

NPI: 1316885890
Provider Name (Legal Business Name): LIFE'S JOURNEY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 NORFOLK SQ
NORFOLK VA
23502-3234
US

IV. Provider business mailing address

1003 NORFOLK SQ
NORFOLK VA
23502-3234
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-0700
  • Fax:
Mailing address:
  • Phone: 757-622-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BENICIA HERNANDEZ
Title or Position: DIRECTOR
Credential: LPC, LSATP
Phone: 757-714-6528