Healthcare Provider Details

I. General information

NPI: 1295973329
Provider Name (Legal Business Name): LIFE ENHANCEMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CLEVELAND AVE SW SUITE 516
ATLANTA GA
30315-7129
US

IV. Provider business mailing address

500 E MOREHEAD ST SUITE 110
CHARLOTTE NC
28202-2616
US

V. Phone/Fax

Practice location:
  • Phone: 404-767-7855
  • Fax: 404-767-7858
Mailing address:
  • Phone: 704-342-3595
  • Fax: 704-342-9584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HERB GRAY
Title or Position: OWNER
Credential:
Phone: 704-342-3595