Provider Demographics
NPI:1912440116
Name:LIFE ENRICHMENT SERVICES, LLC
Entity type:Organization
Organization Name:LIFE ENRICHMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:POST
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-908-8585
Mailing Address - Street 1:133 W SPRINGBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-9527
Mailing Address - Country:US
Mailing Address - Phone:540-908-8585
Mailing Address - Fax:540-901-2485
Practice Address - Street 1:150 W SPRINGBROOK RD
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815
Practice Address - Country:US
Practice Address - Phone:540-908-8585
Practice Address - Fax:540-901-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty