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General NPI Number Information
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NPI Number | 1295223626
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE CHOICES, LLC
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 910 N HAIRSTON RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-2802
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Country | US
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Telephone | 404-484-0180
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Fax | 404-448-3175
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Provider Business Mailing Address
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Address Line | 910 N HAIRSTON RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-2802
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Country | US
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Telephone | 404-484-0180
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | TREVA JONES
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Credential |
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Telephone | 404-835-2565
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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 | CSW006393
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License Number State | GA
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