| A Good Life, Llc | |
|
117 Crescent Dr Williamsburg VA 23188-1043 | |
| (256) 431-8190 | |
| Not Available |
| Full Name | A Good Life, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 117 Crescent Dr, Williamsburg, Virginia |
| Authorized Official Name and Position | Lisa Wolanzyk (OWNER, THERAPIST) |
| Authorized Official Contact | 2564318190 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Good Life, Llc 117 Crescent Dr Williamsburg VA 23188-1043 Ph: (256) 431-8190 | A Good Life, Llc 117 Crescent Dr Williamsburg VA 23188-1043 Ph: (256) 431-8190 |
| NPI Number | 1104511062 |
|---|---|
| Provider Enumeration Date | 04/06/2023 |
| Last Update Date | 04/18/2023 |
| Certification Date | 04/18/2023 |
| Medicare PECOS PAC ID | 3678936978 |
|---|---|
| Medicare Enrollment ID | O20230905002139 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104511062 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 3104A0625X | Assisted Living Facility - Assisted Living, Mental Illness | (* (Not Available)) | Secondary |
| Provider Name | Lisa M Wolanzyk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891056008 PECOS PAC ID: 8224282264 Enrollment ID: I20200619002337 |
| Provider Name | Anne Grethe Difini |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447406855 PECOS PAC ID: 7911245360 Enrollment ID: I20231009000288 |
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