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General NPI Number Information
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NPI Number | 1831431378
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Entity Type | Organization
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Legal Business Name | LIFESKILLS FOR WOMEN
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 03/22/2013
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Provider Practice Location Address
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Address Line | 1816 WALKER ST
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City | AUGUSTA
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State | GA
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Zip | 30904-3659
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Country | US
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Telephone | 706-267-9581
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 204048
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City | AUGUSTA
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State | GA
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Zip | 30917-4048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LYNETTE SAMUEL
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Credential |
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Telephone | 706-863-9971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LPC04525
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License Number State | GA
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