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General NPI Number Information
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NPI Number | 1659227163
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Entity Type | Organization
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Legal Business Name | GOOD LIFE LLC
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 3105 MARTIN LUTHER KING JR AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20032-1537
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Country | US
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Telephone | 240-233-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 MARTIN LUTHER KING JR AVE SE APT 13
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City | WASHINGTON
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State | DC
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Zip | 20032-1577
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Country | US
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Telephone | 240-233-8008
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TYRONE PATE
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Credential |
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Telephone | 202-230-4386
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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 |
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License Number State |
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