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Organization

LONGEVITY NC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANTHONY TYLER QMHP (CO-OWNER)
(804) 800-2500
Entity
Organization

Contact information

Practice address
2006 BELLEFOREST CT, WAXHAW, NC 28173-7381
(804) 800-2500
(804) 800-2600
Mailing address
2006 BELLEFOREST CT, WAXHAW, NC 28173-7381
(804) 800-2500
(804) 800-2600

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
04/18/2026
Last updated
04/29/2026
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