Provider Demographics
NPI:1851065742
Name:ALIGNED LIFE WELLNESS INSTITUTE, LLC
Entity Type:Organization
Organization Name:ALIGNED LIFE WELLNESS INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUTHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-632-1110
Mailing Address - Street 1:1214 KILLINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8244
Mailing Address - Country:US
Mailing Address - Phone:757-632-1110
Mailing Address - Fax:
Practice Address - Street 1:1214 KILLINGTON SQ
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8244
Practice Address - Country:US
Practice Address - Phone:757-632-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)