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General NPI Number Information
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NPI Number | 1063873396
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Entity Type | Organization
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Legal Business Name | REAL LIFE SOLUTIONS GA
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Dates
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Enumeration Date | 03/15/2016
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Last Update Date | 03/15/2016
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Provider Practice Location Address
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Address Line | 8355 CHEROKEE BLVD
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-2591
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Country | US
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Telephone | 770-927-7272
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 641
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City | DOUGLASVILLE
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State | GA
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Zip | 30133-0641
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Country | US
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Telephone | 770-927-7272
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Fax |
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Authorized Official
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Title or Position | CEO/ORGANIZER
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Name | TAMEKIS WILLIAMS
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Credential | LCSW
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Telephone | 770-920-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSW005654
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License Number State | GA
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