Healthcare Provider Details

I. General information

NPI: 1649991589
Provider Name (Legal Business Name): BALANCING LIFE PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENNESAW AVE NW STE 150
MARIETTA GA
30060-7941
US

IV. Provider business mailing address

PO BOX 6181
MARIETTA GA
30065-0181
US

V. Phone/Fax

Practice location:
  • Phone: 470-328-9806
  • Fax:
Mailing address:
  • Phone: 404-936-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ROLAKE TOMOIRI
Title or Position: OWNER/OPERATOR
Credential: PSYD
Phone: 404-936-9455