MEDICARE: L.I.F.T COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1184488595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L.I.F.T COUNSELING

Provider Business Mailing Address
First Line	:	4432 BONNEY RD UNIT 401
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3894
Country	:	US
Telephone Number	:	804-551-4292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 HIGH ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3105
Country	:	US
Telephone Number	:	804-551-4292
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	QUANESHA WALLACE
Credential	:	LPC
Telephone Number	:	804-551-4292

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	02/07/2024

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