Organization
LIFESPAN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DAVAN CLONINGER BA, MA (CEO/PRESIDENT)
(704) 944-5100
Entity
Organization
Contact information
Practice address
627 N MAIN ST, SUITE 1, WAYNESVILLE, NC 28786-3819
(828) 452-1720
(828) 452-1721
Mailing address
200 CLANTON RD, CHARLOTTE, NC 28217-1304
(704) 944-5100
(704) 944-5102
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
MHL-044-041
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300695B
—
NC
Enumeration date
09/11/2007
Last updated
06/03/2013
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