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General NPI Number Information
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NPI Number | 1922868983
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Entity Type | Organization
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Legal Business Name | LIFEPATH WELLNESS, LLC
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 1100 HOWELL MILL RD NW UNIT 613
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City | ATLANTA
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State | GA
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Zip | 30318-8649
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Country | US
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Telephone | 943-457-2059
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 WOODMONT LN NW # 2496
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone | 943-457-2059
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND CEO
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Name | MR. BRADLEY JONES
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Credential | LPC
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Telephone | 943-457-2059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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