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General NPI Number Information
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NPI Number | 1679923668
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Entity Type | Organization
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Legal Business Name | INTENTIONAL LONGEVITY, INC.
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 370 N LOUISIANA AVE SUITE D3 & D4
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City | ASHEVILLE
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State | NC
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Zip | 28806-3600
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Country | US
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Telephone | 828-412-3688
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Fax |
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Provider Business Mailing Address
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Address Line | 370 N LOUISIANA AVE STE D3
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City | ASHEVILLE
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State | NC
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Zip | 28806-3641
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Country | US
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Telephone | 828-412-3688
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Fax | 828-412-3689
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Authorized Official
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Title or Position | DIRECTOR
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Name | ILISHA HARRIS
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Credential | LCMHCA, LCAS, CSI
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Telephone | 740-648-6093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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