Provider Demographics
NPI:1235441882
Name:NEW LIFE SUBSTANCE ABUSE & BEHAVIORAL CONSULTANTS, INC.
Entity Type:Organization
Organization Name:NEW LIFE SUBSTANCE ABUSE & BEHAVIORAL CONSULTANTS, INC.
Other - Org Name:NEW LIFE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER, DIRECTOR OF ADMINISTRATIO
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUINTAINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-486-1143
Mailing Address - Street 1:2697 INTERNATIONAL PKWY
Mailing Address - Street 2:PARKWAY ONE, SUITE 204-1
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7803
Mailing Address - Country:US
Mailing Address - Phone:757-486-1143
Mailing Address - Fax:757-486-1663
Practice Address - Street 1:2697 INTERNATIONAL PKWY
Practice Address - Street 2:PARKWAY ONE, SUITE 204-1
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7803
Practice Address - Country:US
Practice Address - Phone:757-486-1143
Practice Address - Fax:757-486-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102138101YA0400X
VA0701004520101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty