Provider Demographics
NPI:1063833606
Name:LIFE ENRICHMENT CENTER OF VIRGINIA
Entity Type:Organization
Organization Name:LIFE ENRICHMENT CENTER OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHACEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-745-2225
Mailing Address - Street 1:9409 HULL STREET RD STE D1
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1200
Mailing Address - Country:US
Mailing Address - Phone:804-745-2225
Mailing Address - Fax:804-745-2242
Practice Address - Street 1:9409 HULL STREET RD STE D1
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1200
Practice Address - Country:US
Practice Address - Phone:804-745-2225
Practice Address - Fax:804-745-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-28
Last Update Date:2013-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040066151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty