Provider Demographics
NPI:1437223922
Name:LIFE LINE ADDICTIONS FOUNDATION INC.
Entity Type:Organization
Organization Name:LIFE LINE ADDICTIONS FOUNDATION INC.
Other - Org Name:LIFE LINE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LYNDON
Authorized Official - Last Name:SWANBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LSATP, MAC
Authorized Official - Phone:703-691-3029
Mailing Address - Street 1:4308 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTON
Mailing Address - State:VA
Mailing Address - Zip Code:22724-2001
Mailing Address - Country:US
Mailing Address - Phone:540-347-9531
Mailing Address - Fax:703-691-7410
Practice Address - Street 1:10374 DEMOCRACY LN STE A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2557
Practice Address - Country:US
Practice Address - Phone:703-691-3029
Practice Address - Fax:703-691-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000188101YA0400X
VA09040062651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty