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General NPI Number Information
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NPI Number | 1548508476
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Entity Type | Organization
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Legal Business Name | LIFE IMPACT SOLUTIONS, PLLC
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 15036 ARTHUR DAVIS ROAD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3675
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Country | US
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Telephone | 980-202-1747
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Fax | 704-316-2209
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Provider Business Mailing Address
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Address Line | 6611 ALLNESS GLEN LN
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City | CHARLOTTE
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State | NC
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Zip | 28269-6913
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Country | US
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Telephone | 980-202-1747
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Fax | 704-316-2209
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | MS. ZARIA DAVIS HUMPHRIES
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Credential | LCSW
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Telephone | 980-202-1747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | C006469
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License Number State | NC
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