Healthcare Provider Details

I. General information

NPI: 1942509096
Provider Name (Legal Business Name): LIVE LIFE NOW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 OAKLEIGH LN
DALLAS GA
30132-4462
US

IV. Provider business mailing address

192 OAKLEIGH LN
DALLAS GA
30132-4462
US

V. Phone/Fax

Practice location:
  • Phone: 404-396-4979
  • Fax:
Mailing address:
  • Phone: 404-396-4979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number00073318
License Number StateGA

VIII. Authorized Official

Name: TONYA FELICIA LANDIS
Title or Position: REHABILITATION COUNSELOR
Credential: MA,CRC
Phone: 404-396-4979