Healthcare Provider Details

I. General information

NPI: 1831431378
Provider Name (Legal Business Name): LIFESKILLS FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 WALKER ST
AUGUSTA GA
30904-3659
US

IV. Provider business mailing address

PO BOX 204048
AUGUSTA GA
30917-4048
US

V. Phone/Fax

Practice location:
  • Phone: 706-267-9581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberLPC04525
License Number StateGA

VIII. Authorized Official

Name: LYNETTE SAMUEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 706-863-9971