Provider Demographics
NPI:1982935359
Name:LIFE COACH COMMUNITY SERVICES OF VIRGINIA, INC.
Entity Type:Organization
Organization Name:LIFE COACH COMMUNITY SERVICES OF VIRGINIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PARSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-230-4760
Mailing Address - Street 1:PO BOX 74100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-0002
Mailing Address - Country:US
Mailing Address - Phone:804-230-4760
Mailing Address - Fax:
Practice Address - Street 1:180 BELT BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-1204
Practice Address - Country:US
Practice Address - Phone:804-230-4760
Practice Address - Fax:804-230-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-24
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA788251S00000X
VA788-17-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health