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General NPI Number Information
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NPI Number | 1255172367
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Entity Type | Organization
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Legal Business Name | LIFE STAGES INC.
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1079 SPRUCE ST STE A
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City | MARTINSVILLE
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State | VA
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Zip | 24112-4542
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Country | US
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Telephone | 276-634-8683
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3066
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City | MARTINSVILLE
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State | VA
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Zip | 24115-3066
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TOREY MORRIS
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Credential |
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Telephone | 732-330-8683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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