Provider Demographics
NPI:1679342372
Name:LIFEWISE, LLC
Entity Type:Organization
Organization Name:LIFEWISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:251-979-7371
Mailing Address - Street 1:28080 US HIGHWAY 98 STE C
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7012
Mailing Address - Country:US
Mailing Address - Phone:251-586-8541
Mailing Address - Fax:251-586-8561
Practice Address - Street 1:28080 US HIGHWAY 98 STE C
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7012
Practice Address - Country:US
Practice Address - Phone:251-586-8541
Practice Address - Fax:251-586-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health