Provider Demographics
NPI:1639533672
Name:LIFE'S JOURNEY
Entity type:Organization
Organization Name:LIFE'S JOURNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:LENISE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-622-0700
Mailing Address - Street 1:2551 ELTHAM AVE STE F
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2505
Mailing Address - Country:US
Mailing Address - Phone:757-622-0700
Mailing Address - Fax:757-622-2400
Practice Address - Street 1:2551 ELTHAM AVE STE F
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2505
Practice Address - Country:US
Practice Address - Phone:757-622-0700
Practice Address - Fax:757-622-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health