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General NPI Number Information
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NPI Number | 1881312569
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Entity Type | Organization
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Legal Business Name | LIFE BALANCE THERAPY SERVICES
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 633 ROYAL PALM DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3730
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Country | US
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Telephone | 757-384-5620
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Fax |
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Provider Business Mailing Address
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Address Line | 633 ROYAL PALM DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3730
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Country | US
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Telephone | 757-384-5620
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | KIM RICHARDSON
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Credential |
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Telephone | 757-907-2567
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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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