1255578662 NPI number — COUNSELING AND LIFE COACH SERVICES LLC

Table of content: (NPI 1255578662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255578662 NPI number — COUNSELING AND LIFE COACH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING AND LIFE COACH SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255578662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
722 COLLINS HILL RD
Provider Second Line Business Mailing Address:
SUITE H-311
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-496-5041
Provider Business Mailing Address Fax Number:
404-424-9383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3455 LAWRENCEVILLE SUWANEE RD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-6425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-496-5041
Provider Business Practice Location Address Fax Number:
404-424-9383
Provider Enumeration Date:
01/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SIMS
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER (COUNSELOR)
Authorized Official Telephone Number:
404-496-5041

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LPC790 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1790855963 . This is a "NOT SURE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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