Organization
LGBT LIFE CENTER
Active
Other names
Candii
Organization subpart
No
Provider details
NPI number
Authorized official
KIM RICHARDSON (BILLING/CREDENTIALING)
(757) 907-2567
Entity
Organization
Contact information
Practice address
222 W 21ST ST # F-308, NORFOLK, VA 23517-2200
(757) 640-0929
(757) 622-8932
Mailing address
222 W 21ST ST # F-308, NORFOLK, VA 23517-2200
(757) 907-2567
(757) 578-2863
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0087422272
—
VA
05
—
1497047237
—
VA
Enumeration date
05/12/2011
Last updated
07/06/2020
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