Longevity NC, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LONGEVITY NC, LLC

Practice address

2006 Belleforest CT
Waxhaw, NC 28173-7381

Phone

(804) 800-2500

Fax

(804) 800-2600

NPI assigned

Apr 18, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anthony Tyler, QMHP

Title

Co-Owner

Phone

(804) 800-2500

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1776470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777420800000",
    "number": "1174467179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2006 BELLEFOREST CT",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281737381",
            "telephone_number": "804-800-2500",
            "fax_number": "804-800-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 BELLEFOREST CT",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281737381",
            "telephone_number": "804-800-2500",
            "fax_number": "804-800-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY NC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-18",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A",
        "authorized_official_last_name": "TYLER",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "804-800-2500",
        "authorized_official_credential": "QMHP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lifepath Holistic Counseling and Consulting, PLLC.
• Allison Whaley Lints, MED, NCC, LPCA
• Little Roots Therapy
• Whitney Boglioli Lodigiani, M.S. CCC-S:P
• Londry, Modlin, Tucker IV DDS PLLC
• Lorette M. Polite-Young DDS PA
• Gin Wen Lou
• Jenna Lowery, MOT/L
• Rachael Luscombe
• Jennifer Lyash

• Community/Behavioral Health Agency in Waxhaw, NC
• Providers in Waxhaw, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.