MEDICARE: ENVISIONS OF LIFE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NC
2	101YM0800X	Mental Health Counselor	NC
3	101YP2500X	Professional Counselor
4	251B00000X	Case Management Agency	NC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881788818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISIONS OF LIFE LLC

Provider Business Mailing Address
First Line	:	5 CENTERVIEW DR STE 110
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-3709
Country	:	US
Telephone Number	:	336-887-0708
Fax Number	:	336-887-1085

Provider Business Practice Location Address
First Line	:	5 CENTERVIEW DR STE 110
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-3709
Country	:	US
Telephone Number	:	336-887-0708
Fax Number	:	336-887-1085

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARVA MATHIS
Credential	:	BS,
Telephone Number	:	336-887-0708

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/20/2026

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Directions to “ENVISIONS OF LIFE LLC ” Practice Location

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