Healthcare Provider Details

I. General information

NPI: 1154723617
Provider Name (Legal Business Name): LEADERS FOR LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BREMO RD STE 200
RICHMOND VA
23226-2440
US

IV. Provider business mailing address

2000 BREMO RD
RICHMOND VA
23226-2440
US

V. Phone/Fax

Practice location:
  • Phone: 804-477-6137
  • Fax: 804-800-4222
Mailing address:
  • Phone: 804-477-6137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: FATIMA SMITH
Title or Position: CEO
Credential:
Phone: 804-477-6137