Provider Demographics
NPI:1003623976
Name:LIFE SOLUTIONS LLC
Entity type:Organization
Organization Name:LIFE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP-A
Authorized Official - Phone:540-871-5552
Mailing Address - Street 1:5451 NORTH LAKES DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019
Mailing Address - Country:US
Mailing Address - Phone:540-871-5552
Mailing Address - Fax:
Practice Address - Street 1:3959 ELECTRIC RD STE 107
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4562
Practice Address - Country:US
Practice Address - Phone:540-871-5552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty