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General NPI Number Information
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NPI Number | 1891992673
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Entity Type | Organization
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Legal Business Name | ENVISIONS OF LIFE LLC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 218 N MCPHERSON CHURCH RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-4495
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Country | US
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Telephone | 910-323-6002
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Fax | 910-323-6003
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Provider Business Mailing Address
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Address Line | 204 KELLY PL
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City | HIGH POINT
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State | NC
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Zip | 27262-2609
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Country | US
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Telephone | 336-887-0708
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Fax | 336-887-1085
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TOMEKO MICHELLE MOORE
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Credential |
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Telephone | 336-887-0708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | NC
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