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General NPI Number Information
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NPI Number | 1184488595
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Entity Type | Organization
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Legal Business Name | L.I.F.T COUNSELING
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 1801 HIGH ST
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City | PORTSMOUTH
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State | VA
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Zip | 23704-3105
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Country | US
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Telephone | 804-551-4292
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Fax |
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Provider Business Mailing Address
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Address Line | 4432 BONNEY RD UNIT 401
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3894
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Country | US
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Telephone | 804-551-4292
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | QUANESHA WALLACE
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Credential | LPC
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Telephone | 804-551-4292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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