Provider Demographics
NPI:1407085038
Name:LIFES JOURNEY
Entity Type:Organization
Organization Name:LIFES JOURNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:1919-264-6246
Mailing Address - Street 1:3605 EASTERN BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5668
Mailing Address - Country:US
Mailing Address - Phone:191-926-4624
Mailing Address - Fax:
Practice Address - Street 1:3605 EASTERN BRANCH RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5668
Practice Address - Country:US
Practice Address - Phone:191-926-4624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health