Provider Demographics
NPI:1548508476
Name:LIFE IMPACT SOLUTIONS, PLLC
Entity type:Organization
Organization Name:LIFE IMPACT SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ZARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:980-202-1747
Mailing Address - Street 1:6611 ALLNESS GLEN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6913
Mailing Address - Country:US
Mailing Address - Phone:980-202-1747
Mailing Address - Fax:704-316-2209
Practice Address - Street 1:15036 ARTHUR DAVIS ROAD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3675
Practice Address - Country:US
Practice Address - Phone:980-202-1747
Practice Address - Fax:704-316-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC006469251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health