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General NPI Number Information
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NPI Number | 1144096710
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Entity Type | Organization
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Legal Business Name | LIFESPAN COUNSELING OF ATLANTA, LLC
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1924 CLAIRMONT RD STE 105
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City | DECATUR
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State | GA
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Zip | 30033-3438
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Country | US
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Telephone | 678-907-3106
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 OAKBROOK LN
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City | CLARKSTON
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State | GA
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Zip | 30021-1004
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Country | US
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Telephone | 678-907-3106
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER/MENTAL HEALTH COUNSELOR
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Name | ELIZABETH NATALIE VALERA
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Credential | LPC
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Telephone | 678-907-3106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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