Healthcare Provider Details

I. General information

NPI: 1265377626
Provider Name (Legal Business Name): LIFEOLOGIE SANDY SPRINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 HIGHTOWER TRL STE 105
SANDY SPRINGS GA
30350-2917
US

IV. Provider business mailing address

1301 HIGHTOWER TRL STE 105
SANDY SPRINGS GA
30350-2917
US

V. Phone/Fax

Practice location:
  • Phone: 678-916-6437
  • Fax: 678-855-6627
Mailing address:
  • Phone: 678-916-6437
  • Fax: 678-855-6627

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: DR. AMANI AMANDA MUNGO
Title or Position: OWNER/ CLINICAL DIRECTOR
Credential: LPC, CPCS
Phone: 678-916-6427