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General NPI Number Information
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NPI Number | 1285024810
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Entity Type | Organization
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Legal Business Name | LIFE TRANSFORMATION PSYCHOLOGICAL CENTER, PC
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 1755 N BROWN RD SUITE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8198
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Country | US
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Telephone | 706-530-1504
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Fax | 855-420-6045
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Provider Business Mailing Address
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Address Line | 950 HERRINGTON RD SUITE C 186
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7217
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Country | US
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Telephone | 706-530-1504
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. ELIZABETH L. ANDERSON
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Credential | PSY.D.
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Telephone | 706-530-1504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY003783
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License Number State | GA
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