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General NPI Number Information
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NPI Number | 1104613926
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Entity Type | Individual
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Provider Name | CHRIST-LEE LIZAIRE-GANTHIER
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Gender | Female
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 2055 GEES MILL RD NE
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City | CONYERS
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State | GA
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Zip | 30013-1362
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Country | US
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Telephone | 404-931-1797
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Fax |
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Provider Business Mailing Address
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Address Line | 5431 CONFEDERATE CAMP CIR SW
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City | CONYERS
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State | GA
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Zip | 30094-4755
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Country | US
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Telephone | 404-931-1797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171R00000X
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Taxonomy Name | Interpreter
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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