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General NPI Number Information
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NPI Number | 1336573872
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Entity Type | Organization
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Legal Business Name | LIFE SERVICES INC
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Dates
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Enumeration Date | 09/01/2013
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 3816 CANDLEGROVE CT
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City | RICHMOND
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State | VA
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Zip | 23223-1440
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Country | US
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Telephone | 866-935-3314
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Fax | 804-329-9292
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Provider Business Mailing Address
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Address Line | PO BOX 603
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-0603
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Country | US
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Telephone | 866-935-3314
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Fax | 804-329-9292
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Authorized Official
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Title or Position | EXECUTIVE DIRECTER
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Name | MR. ERIC ANTHONY GOODE
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Credential |
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Telephone | 804-869-7117
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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 | 1986-03-001
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License Number State | VA
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