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Organization
ENVISIONS OF LIFE LLC
Active
Organization
ENVISIONS OF LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMEKO MICHELLE MOORE (PRESIDENT)
(336) 887-0708
Entity
Organization
Contact information
Practice address
5 CENTERVIEW DRIVE, SUITE 110, GREENSBORO, NC 27407-3709
(336) 887-0708
(336) 887-1085
Mailing address
5 CENTERVIEW DR., SUITE 110, GREENSBORO, NC 27407-3709
(336) 887-0708
(336) 887-1085
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
NC
251S00000X
Community/Behavioral Health Agency
—
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6006285
—
NC
Enumeration date
10/23/2012
Last updated
03/25/2015
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