Provider Demographics
NPI:1306912860
Name:A BETTER LIFE EXPERIENCE, INC.
Entity type:Organization
Organization Name:A BETTER LIFE EXPERIENCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:WOOLDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-829-2393
Mailing Address - Street 1:700 SOUTHRIDGE PKWY
Mailing Address - Street 2:SUITE 301B
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3723
Mailing Address - Country:US
Mailing Address - Phone:540-829-2393
Mailing Address - Fax:
Practice Address - Street 1:700 SOUTHRIDGE PKWY
Practice Address - Street 2:SUITE 301B
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3723
Practice Address - Country:US
Practice Address - Phone:540-829-2393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040034631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008911339Medicaid
VA008911339Medicaid