Provider Demographics
NPI:1811647019
Name:LIFE TRAJECTORIES
Entity type:Organization
Organization Name:LIFE TRAJECTORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:FLANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-844-0774
Mailing Address - Street 1:8601 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5276
Mailing Address - Country:US
Mailing Address - Phone:984-528-0304
Mailing Address - Fax:
Practice Address - Street 1:8601 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5276
Practice Address - Country:US
Practice Address - Phone:984-528-0304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIOR AGENTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health