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General NPI Number Information
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NPI Number | 1003623976
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Entity Type | Organization
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Legal Business Name | LIFE SOLUTIONS LLC
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Dates
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Enumeration Date | 12/14/2024
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 3959 ELECTRIC RD STE 107
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City | ROANOKE
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State | VA
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Zip | 24018-4562
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Country | US
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Telephone | 540-871-5552
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Fax |
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Provider Business Mailing Address
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Address Line | 5451 NORTH LAKES DRIVE
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City | ROANOKE
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State | VA
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Zip | 24019
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Country | US
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Telephone | 540-871-5552
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MR. PETER J WALLACE
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Credential | QMHP-A
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Telephone | 540-871-5552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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