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General NPI Number Information
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NPI Number | 1417374398
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Entity Type | Organization
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Legal Business Name | REALIZE LIFE COACHING, LLC
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 1924 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-3438
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Country | US
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Telephone | 404-964-9814
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Fax |
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Provider Business Mailing Address
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Address Line | 949 LONGLEY AVE NW
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City | ATLANTA
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State | GA
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Zip | 30318-5205
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Country | US
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Telephone | 404-964-9814
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER AND LIFE COACH
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Name | MARCIA MILLER
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Credential | MPH, LMSW
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Telephone | 404-964-9814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW005540
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License Number State | GA
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