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General NPI Number Information
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NPI Number | 1487055919
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Entity Type | Organization
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Legal Business Name | LIFEWORKS SUBSTANCE ABUSE SERVICES LLC
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 4678 TAMIAMI TRL #105
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2900
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Country | US
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Telephone | 941-979-5023
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Fax | 941-979-5064
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Provider Business Mailing Address
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Address Line | 4678 TAMIAMI TRL #105
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2900
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Country | US
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Telephone | 941-979-5023
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Fax | 941-979-5064
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Authorized Official
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Title or Position | CEO
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Name | DR. RHOADIE LADD
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Credential |
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Telephone | 941-979-5023
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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 | MH8565
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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