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General NPI Number Information
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NPI Number | 1649741174
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Entity Type | Organization
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Legal Business Name | GOOD LIFE COUNSELING AND CONSULTING
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Dates
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Enumeration Date | 12/10/2018
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 1585 OLD NORCROSS RD STE 204D
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4043
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Country | US
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Telephone | 678-963-2725
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Fax |
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Provider Business Mailing Address
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Address Line | 1151 AUGUSTINE DR
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City | AUBURN
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State | GA
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Zip | 30011-3097
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Country | US
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Telephone | 201-704-5585
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | TERESA COLMAN
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Credential | LPC
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Telephone | 201-704-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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