Provider Demographics
NPI:1104511062
Name:A GOOD LIFE, LLC
Entity type:Organization
Organization Name:A GOOD LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLANZYK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:256-431-8190
Mailing Address - Street 1:117 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1043
Mailing Address - Country:US
Mailing Address - Phone:256-431-8190
Mailing Address - Fax:
Practice Address - Street 1:117 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1043
Practice Address - Country:US
Practice Address - Phone:256-431-8190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness