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General NPI Number Information
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NPI Number | 1770929150
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Entity Type | Organization
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Legal Business Name | CIRCLE OF FRIENDS: CELEBRATING LIFE, INC
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Dates
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Enumeration Date | 05/13/2013
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 806 OLD MILL TRL
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City | BALL GROUND
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State | GA
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Zip | 30107-5182
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Country | US
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Telephone | 678-783-0126
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Fax | 678-935-3997
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Provider Business Mailing Address
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Address Line | 401 WESTPARK CT SUITE 200
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3572
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Country | US
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Telephone | 678-850-1064
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Fax | 678-935-3997
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LISA WILLIAMS
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Credential |
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Telephone | 678-850-1064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 155014LEX
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License Number State | GA
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