Provider Demographics
NPI:1326764283
Name:LIFESPAN BEHAVIORAL SERVICES PLC
Entity Type:Organization
Organization Name:LIFESPAN BEHAVIORAL SERVICES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:WINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA, LBA
Authorized Official - Phone:321-427-2438
Mailing Address - Street 1:2333 SCHENLEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3317
Mailing Address - Country:US
Mailing Address - Phone:321-427-2438
Mailing Address - Fax:
Practice Address - Street 1:2333 SCHENLEY DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3317
Practice Address - Country:US
Practice Address - Phone:321-427-2438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty