Organization
LIFE ENHANCEMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HERBERT A GRAY III (CEO/OWNER)
(980) 265-1064
Entity
Organization
Contact information
Practice address
455 RAST ST, SUITE A, SUMTER, SC 29150-2579
(704) 560-4332
Mailing address
9700 RESEARCH DR, SUITE 111, CHARLOTTE, NC 28262-8552
(980) 265-1064
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109BHS
—
SC
Enumeration date
08/19/2010
Last updated
01/28/2016
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