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General NPI Number Information
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NPI Number | 1609746494
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Entity Type | Organization
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Legal Business Name | NEW LIFE CENTER LLC
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 90 FORT WADE RD STE 100-1028
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5146
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Country | US
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Telephone | 910-506-4018
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2153
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City | LAURINBURG
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State | NC
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Zip | 28353-2153
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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 | CEO
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Name | ROBERT SMITH
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Credential | MSW, LCSW, LCAS, CCS
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Telephone | 910-506-4018
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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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