Provider Demographics
NPI:1528314333
Name:LIFE DIRECTIONS, LLC
Entity type:Organization
Organization Name:LIFE DIRECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIDA
Authorized Official - Middle Name:LYNNE PENN
Authorized Official - Last Name:PICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-418-6533
Mailing Address - Street 1:501 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5715
Mailing Address - Country:US
Mailing Address - Phone:240-625-9180
Mailing Address - Fax:240-452-3007
Practice Address - Street 1:240 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6005
Practice Address - Country:US
Practice Address - Phone:240-625-9180
Practice Address - Fax:240-452-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty