MEDICARE: CONNECTIONS FOR LIFE COUNSELING, LLC

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	0701004235	VA

General Provider Information

NPI Number	:	1902138100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTIONS FOR LIFE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	7400 BROOK ROAD
Second Line	:	SUITE C
City	:	HENRICO
State	:	VA
Zip	:	23227
Country	:	US
Telephone Number	:	804-261-2225
Fax Number	:	804-261-2226

Provider Business Practice Location Address
First Line	:	7400 BROOK ROAD
Second Line	:	SUITE C
City	:	HENRICO
State	:	VA
Zip	:	23227
Country	:	US
Telephone Number	:	804-261-2225
Fax Number	:	804-261-2226

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	CANDYCE CONNER
Credential	:
Telephone Number	:	804-502-9847

Provider Enumeration Date	:	02/12/2010
Last Update Date	:	02/12/2010

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