Provider Demographics
NPI:1447309828
Name:RECOVERING LIFE PC
Entity type:Organization
Organization Name:RECOVERING LIFE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER, RECOVERING LIFE PC
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:MCGLOTHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-889-1954
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-2045
Mailing Address - Country:US
Mailing Address - Phone:276-889-1954
Mailing Address - Fax:276-889-4955
Practice Address - Street 1:750 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-2045
Practice Address - Country:US
Practice Address - Phone:276-889-1954
Practice Address - Fax:276-889-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447309828Medicaid
VA1447309828Medicaid