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General NPI Number Information
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NPI Number | 1104298389
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Entity Type | Organization
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Legal Business Name | LIFE TRANSITIONS INC.
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 956 LAKE VILLAGE DR APT C
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City | CHESAPEAKE
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State | VA
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Zip | 23323-4725
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Country | US
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Telephone | 757-372-3534
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Fax | 757-673-1302
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Provider Business Mailing Address
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Address Line | 956 LAKE VILLAGE DR APT C
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City | CHESAPEAKE
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State | VA
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Zip | 23323-4725
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Country | US
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Telephone | 757-372-3534
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Fax | 757-673-1302
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Authorized Official
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Title or Position | CEO
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Name | MRS. CARMALITA YVONNE KOVACH-WATTS
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Credential |
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Telephone | 757-372-3534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 309971
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License Number State | VA
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