MEDICARE: NEW LYFE COUNSELING SERVICES

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346822392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LYFE COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	6601 IRONGATE SQ STE A&B
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6077
Country	:	US
Telephone Number	:	804-621-4228
Fax Number	:	804-621-4231

Provider Business Practice Location Address
First Line	:	6601 IRONGATE SQ STE A&B
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6077
Country	:	US
Telephone Number	:	804-621-4228
Fax Number	:	804-621-4231

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MS. DETRINA EVETTE CRAWLEY
Credential	:
Telephone Number	:	804-621-4228

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	03/07/2026

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