Healthcare Provider Details

I. General information

NPI: 1063838126
Provider Name (Legal Business Name): NEW LIFESTYLES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W BOSCAWEN ST
WINCHESTER VA
22601-4118
US

IV. Provider business mailing address

PO BOX 64
WINCHESTER VA
22604-0064
US

V. Phone/Fax

Practice location:
  • Phone: 540-722-4521
  • Fax: 540-722-0223
Mailing address:
  • Phone: 540-722-4521
  • Fax: 540-722-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH L CUAVE
Title or Position: PRESIDENT
Credential: PSYD
Phone: 540-722-4521