Organization
ENVISIONS OF LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TOMEKO MICHELLE MOORE (PRESIDENT)
(336) 887-0708
Entity
Organization
Contact information
Practice address
218 N MCPHERSON CHURCH RD, FAYETTEVILLE, NC 28303-4495
(910) 323-6002
(910) 323-6003
Mailing address
204 KELLY PL, HIGH POINT, NC 27262-2609
(336) 887-0708
(336) 887-1085
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
251B00000X
Case Management Agency
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950233
—
NC
05
—
8301519
—
NC
05
—
8301519A
—
NC
05
—
8301519B
—
NC
05
—
8301519G
—
NC
Enumeration date
06/27/2007
Last updated
04/29/2010
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