Provider Demographics
NPI:1104298389
Name:LIFE TRANSITIONS INC.
Entity type:Organization
Organization Name:LIFE TRANSITIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMALITA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:KOVACH-WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-372-3534
Mailing Address - Street 1:956 LAKE VILLAGE DR APT C
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-4725
Mailing Address - Country:US
Mailing Address - Phone:757-372-3534
Mailing Address - Fax:757-673-1302
Practice Address - Street 1:956 LAKE VILLAGE DR APT C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-4725
Practice Address - Country:US
Practice Address - Phone:757-372-3534
Practice Address - Fax:757-673-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA309971305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization