Provider Demographics
NPI:1811728801
Name:LIFEWELL PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:LIFEWELL PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JERRICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-231-7401
Mailing Address - Street 1:834 44TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2045
Mailing Address - Country:US
Mailing Address - Phone:757-231-7401
Mailing Address - Fax:757-743-3015
Practice Address - Street 1:834 44TH ST STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2045
Practice Address - Country:US
Practice Address - Phone:757-231-7401
Practice Address - Fax:757-743-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty