Provider Demographics
NPI:1114464526
Name:EMBRACE LIFE, LLC
Entity Type:Organization
Organization Name:EMBRACE LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:PERL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, BCPCC
Authorized Official - Phone:917-515-7884
Mailing Address - Street 1:238 TOLUCA RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-1852
Mailing Address - Country:US
Mailing Address - Phone:917-515-7884
Mailing Address - Fax:
Practice Address - Street 1:238 TOLUCA RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-1852
Practice Address - Country:US
Practice Address - Phone:917-515-7884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty