Provider Demographics
NPI:1346822392
Name:NEW LYFE COUNSELING SERVICES
Entity Type:Organization
Organization Name:NEW LYFE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:DETRINA
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:CRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:804-621-4228
Mailing Address - Street 1:1601 WARE BOTTOM SPRING RD STE 208
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2599
Mailing Address - Country:US
Mailing Address - Phone:804-621-4228
Mailing Address - Fax:804-621-4231
Practice Address - Street 1:1601 WARE BOTTOM SPRING RD STE 208
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2599
Practice Address - Country:US
Practice Address - Phone:804-621-4228
Practice Address - Fax:804-621-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA605324315Medicaid