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General NPI Number Information
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NPI Number | 1861090615
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Entity Type | Organization
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Legal Business Name | ENERGY FOR LIFE, LLC
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 2600 BROWNSTONE CIR
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-8321
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Country | US
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Telephone | 757-696-2370
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 BROWNSTONE CIR
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-8321
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Country | US
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Telephone | 757-696-2370
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Fax |
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Authorized Official
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Title or Position | CEO, OWNER
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Name | DR. LISA J CLARKE
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Credential | PSYD.
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Telephone | 757-696-2370
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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 |
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License Number State |
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