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General NPI Number Information
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NPI Number | 1487054342
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Entity Type | Organization
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Legal Business Name | IMPACT LIVING SERVICES
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 630 WYNDHURST DR SUITE F
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City | LYNCHBURG
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State | VA
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Zip | 24502-3454
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Country | US
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Telephone | 434-533-1088
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Fax |
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Provider Business Mailing Address
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Address Line | 630 WYNDHURST DR SUITE F
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City | LYNCHBURG
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State | VA
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Zip | 24502-3454
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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 | MR. DAN EDWIN WEST JR.
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Credential |
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Telephone | 434-660-2917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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