| Lgbt Life Center | |
|
222 W 21st St # F-308 Norfolk VA 23517-2200 | |
| (757) 640-0929 | |
| (757) 622-8932 |
| Full Name | Lgbt Life Center |
|---|---|
| Speciality | Counselor |
| Location | 222 W 21st St # F-308, Norfolk, Virginia |
| Authorized Official Name and Position | Kim Richardson (BILLING/CREDENTIALING) |
| Authorized Official Contact | 7579072567 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lgbt Life Center 222 W 21st St # F-308 Norfolk VA 23517-2200 Ph: (757) 907-2567 | Lgbt Life Center 222 W 21st St # F-308 Norfolk VA 23517-2200 Ph: (757) 640-0929 |
| NPI Number | 1497047237 |
|---|---|
| Provider Enumeration Date | 05/12/2011 |
| Last Update Date | 07/06/2020 |
| Certification Date | 07/06/2020 |
| Medicare PECOS PAC ID | 3971924689 |
|---|---|
| Medicare Enrollment ID | O20200604003211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497047237 | NPI | - | NPPES |
| 0087422272 | Medicaid | VA | |
| 1497047237 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Venitta R Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124368691 PECOS PAC ID: 5496055519 Enrollment ID: I20151121000302 |
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