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General NPI Number Information
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NPI Number | 1144727389
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Entity Type | Organization
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Legal Business Name | ANEW LIVING LLC
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 21206 CHESTERFIELD AVE STE B
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City | SOUTH CHESTERFIELD
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State | VA
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Zip | 23803-1920
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Country | US
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Telephone | 804-451-9939
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Fax |
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Provider Business Mailing Address
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Address Line | 21206 CHESTERFIELD AVE STE B
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City | SOUTH CHESTERFIELD
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State | VA
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Zip | 23803-1920
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Country | US
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Telephone | 804-451-9939
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Fax |
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Authorized Official
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Title or Position | CEO/PROGRAM DIRECTOR
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Name | MS. LATOYA L GREEN
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Credential | QMHP
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Telephone | 804-451-9939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2989
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License Number State | VA
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