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General NPI Number Information
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NPI Number | 1124842034
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Entity Type | Organization
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Legal Business Name | REDESIGN YOUR LIFE COUNSELING LLC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 130 N GROSS RD STE 205
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City | KINGSLAND
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State | GA
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Zip | 31548-6277
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Country | US
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Telephone | 912-467-9538
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Fax |
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Provider Business Mailing Address
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Address Line | 121TIDAL MARSH WAY
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City | SAINT MARYS
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State | GA
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Zip | 31558-5809
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Country | US
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Telephone | 912-467-9538
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ALESSANDRA M ELLIS-LODMELL
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Credential | LCSW
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Telephone | 912-467-9538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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