Healthcare Provider Details

I. General information

NPI: 1063763720
Provider Name (Legal Business Name): PARADISE FOR LIVING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 W PARK CT STE ABC
STONE MOUNTAIN GA
30087-3550
US

IV. Provider business mailing address

1145 PINE LAKE DR
GRAYSON GA
30017-7926
US

V. Phone/Fax

Practice location:
  • Phone: 404-522-3555
  • Fax: 678-374-4421
Mailing address:
  • Phone: 678-446-8288
  • Fax: 678-374-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIE E SAMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 678-446-8288