Provider Demographics
NPI:1336573872
Name:LIFE SERVICES INC
Entity Type:Organization
Organization Name:LIFE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-869-7117
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-0603
Mailing Address - Country:US
Mailing Address - Phone:866-935-3314
Mailing Address - Fax:804-329-9292
Practice Address - Street 1:3816 CANDLEGROVE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-1440
Practice Address - Country:US
Practice Address - Phone:866-935-3314
Practice Address - Fax:804-329-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-01
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1986-03-001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty