Provider Demographics
NPI:1427745751
Name:NEW LIFESCAPE COUNSELING, LLC
Entity type:Organization
Organization Name:NEW LIFESCAPE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-709-9899
Mailing Address - Street 1:296 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-2203
Mailing Address - Country:US
Mailing Address - Phone:540-330-9604
Mailing Address - Fax:
Practice Address - Street 1:5330 AIR PORT RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012
Practice Address - Country:US
Practice Address - Phone:540-309-6049
Practice Address - Fax:540-779-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982316808Medicaid
VA1982316808OtherANTHEM, AETNA CIGNA, HUMANA, UNITED HEALTHCARE