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General NPI Number Information
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NPI Number | 1295267268
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE COUNSELING
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 2521 MOUNTAIN VIEW RD SUITE 4
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City | GAINESVILLE
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State | GA
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Zip | 30504-5829
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Country | US
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Telephone | 678-752-4335
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Fax | 678-649-2101
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Provider Business Mailing Address
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Address Line | 2521 MOUNTAIN VIEW RD SUITE 4
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City | GAINESVILLE
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State | GA
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Zip | 30504-5829
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Country | US
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Telephone | 678-752-4335
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Fax | 678-649-2101
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA DUTTON
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Credential | LPC
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Telephone | 678-752-4335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | LPC009255
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | LPC009255
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | LPC009255
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License Number State | GA
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