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General NPI Number Information
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NPI Number | 1174982474
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Entity Type | Organization
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Legal Business Name | GENESIS OF LIFE INC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 316 ALEXANDER ST SE STE 2
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City | MARIETTA
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State | GA
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Zip | 30060-8217
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Country | US
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Telephone | 404-604-0544
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Fax | 404-585-4421
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Provider Business Mailing Address
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Address Line | 316 ALEXANDER ST SE STE 2
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City | MARIETTA
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State | GA
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Zip | 30060-8217
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Country | US
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Telephone | 404-604-0544
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Fax | 404-585-4421
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRITTANY MOSELY
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Credential | LPC
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Telephone | 404-604-0544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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