Provider Demographics
NPI:1568197440
Name:LIFESPAN WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:LIFESPAN WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPANFELNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-418-6399
Mailing Address - Street 1:65 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1741
Mailing Address - Country:US
Mailing Address - Phone:540-418-6399
Mailing Address - Fax:
Practice Address - Street 1:65 E COURT ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1741
Practice Address - Country:US
Practice Address - Phone:540-418-6399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)