# ENVISIONS OF LIFE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104179555
- **Authorized official:** TOMEKO MICHELLE MOORE (PRESIDENT)
- **Authorized official phone:** (336) 887-0708

## Contact information

- **Practice address:** 5 CENTERVIEW DRIVE, SUITE 110, GREENSBORO, NC 27407-3709
- **Practice address phone:** (336) 887-0708
- **Practice address fax:** (336) 887-1085
- **Mailing address:** 5 CENTERVIEW DR., SUITE 110, GREENSBORO, NC 27407-3709
- **Mailing address phone:** (336) 887-0708
- **Mailing address fax:** (336) 887-1085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NC | — |
| 251S00000X | Community/Behavioral Health Agency | — | NC | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NC | Yes |

## Other

- **Enumeration date:** 10/23/2012
- **Last updated:** 03/25/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6006285 | — | NC |