Healthcare Provider Details

I. General information

NPI: 1265911069
Provider Name (Legal Business Name): CHANGING LIVES COUNSELING SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 PEACHTREE ST NE
ATLANTA GA
30308-1227
US

IV. Provider business mailing address

10831 PANHANDLE RD
HAMPTON GA
30228-1512
US

V. Phone/Fax

Practice location:
  • Phone: 404-772-4000
  • Fax:
Mailing address:
  • Phone: 404-772-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: FELICIA MCDOWELL
Title or Position: CEO
Credential:
Phone: 404-772-4000