Healthcare Provider Details

I. General information

NPI: 1639533672
Provider Name (Legal Business Name): LIFE'S JOURNEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
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: 757-622-2400
Mailing address:
  • Phone: 757-622-0700
  • Fax: 757-622-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANTE LENISE WILLIAMS
Title or Position: COO
Credential:
Phone: 757-622-0700