A Good Life, LLC
Organization Active NPI Community/Behavioral Health Agency · Williamsburg, VA
NPI 1104511062 · NPPES record last updated Apr 18, 2023
Key facts
- NPI
- 1104511062
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- A GOOD LIFE, LLC
- Practice address
- 117 Crescent Dr
Williamsburg, VA 23188-1043 - Phone
- (256) 431-8190
- NPI assigned
- Apr 6, 2023
- Organization subpart
- No
Authorized official
- Name
- Lisa Wolanzyk, LCSW
- Title
- Owner, Therapist
- Phone
- (256) 431-8190
Practitioners 2
-
Lisa Wolanzyk, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230905002139 | VA | Part B Supplier - Clinic/Group Practice | 3678936978 |
Receives reassigned benefits from 2 practitioners Practice locations: Williamsburg, VA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes | ||
| Assisted Living Facility (Mental Illness) | 3104A0625X |
Addresses
Primary practice location
117 Crescent Dr
Williamsburg, VA 23188-1043
Mailing address
117 Crescent Dr
Williamsburg, VA 23188-1043
Phone (256) 431-8190
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All providers in Williamsburg, VA · Community/Behavioral Health Agency in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.