{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "LIFEWORKS WELLNESS,LLC",
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"NamePrefix": null,
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"FirstLineMailingAddress": "2515 BRADFORD SQ NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ATLANTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30345-1338",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "678-772-1161",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3355 LENOX RD NE",
"SecondLinePracticeLocationAddress": "STE 750",
"PracticeLocationAddressCityName": "ATLANTA",
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"PracticeLocationAddressTelephoneNumber": "678-772-1161",
"PracticeLocationAddressFaxNumber": "404-504-7004",
"EnumerationDate": "05/03/2012",
"LastUpdateDate": "05/03/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "ESTHER",
"AuthorizedOfficialMiddleName": "MARIE",
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"AuthorizedOfficialNamePrefix": "MS.",
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"AuthorizedOfficialCredential": "LCSW",
"AuthorizedOfficialTelephoneNumber": "678-772-1161",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Behavioral Health Agency",
"LicenseNumber": "CSW002791",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}