Healthcare Provider Details

I. General information

NPI: 1932056983
Provider Name (Legal Business Name): LIFE IN BALANCE NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 FORTRESS WAY
OCCOQUAN VA
22125-7700
US

IV. Provider business mailing address

PO BOX 88
OCCOQUAN VA
22125-0088
US

V. Phone/Fax

Practice location:
  • Phone: 571-348-4220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: RACHEL B JOHNSON
Title or Position: CERTIFIED NUTRITION SPECIALIST
Credential: CNS/LDN
Phone: 571-221-2156