Healthcare Provider Details

I. General information

NPI: 1164314134
Provider Name (Legal Business Name): LIFE BALANCE COACHING SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 PRESTON RIDGE RD STE 500
ALPHARETTA GA
30005-5460
US

IV. Provider business mailing address

3480 PRESTON RIDGE RD STE 500
ALPHARETTA GA
30005-5460
US

V. Phone/Fax

Practice location:
  • Phone: 404-895-5131
  • Fax:
Mailing address:
  • Phone: 404-895-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ONTKO FREEMAN
Title or Position: OWNER
Credential:
Phone: 330-760-6441