Organization
LIFELONG GOOD HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LUCIA ISAC MITCHELL RDN (REGISTERED DIETITIAN NUTRITIONIST)
(703) 389-6612
Entity
Organization
Contact information
Practice address
5721 RHODE ISALND DRIVE, WOODBRIDGE, VA 22193
(703) 389-6612
Mailing address
14904 JEFFERSON DAVIS HWY, WOODBRIDGE, VA 22191-3908
(703) 389-6612
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
D1100000386
DC
Other
Enumeration date
02/19/2015
Last updated
02/19/2015
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