Provider Demographics
NPI:1831721166
Name:BUILDING LIVES IN UNISON, INC
Entity type:Organization
Organization Name:BUILDING LIVES IN UNISON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:RIDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-679-2583
Mailing Address - Street 1:2655 TIDEWATER DR UNIT 7644
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1294
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2121B KELLER AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3106
Practice Address - Country:US
Practice Address - Phone:757-679-2583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty