=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306912860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A BETTER LIFE EXPERIENCE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 07/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 SOUTHRIDGE PKWY SUITE 301B
-----------------------------------------------------
City | CULPEPER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22701-3723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-829-2393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 SOUTHRIDGE PKWY SUITE 301B
-----------------------------------------------------
City | CULPEPER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22701-3723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-829-2393
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARY JANE ROSE WOOLDRIDGE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 540-829-2393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904003463
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------