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General NPI Number Information
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NPI Number | 1154029288
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Entity Type | Organization
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Legal Business Name | EXAMINED LIFE PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 4445 CORPORATION LN STE 264
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3262
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Country | US
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Telephone | 540-200-8189
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 CORPORATION LN STE 264
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3262
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Country | US
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Telephone | 540-200-8189
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | CODY WOODBURN
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Credential | LPC
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Telephone | 540-200-8189
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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 |
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License Number State |
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