Provider Demographics
NPI:1093054413
Name:LIFE CENTER COUNSELING AND RESOURCES
Entity Type:Organization
Organization Name:LIFE CENTER COUNSELING AND RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:404-425-8757
Mailing Address - Street 1:3949 PERRY PASS
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-7730
Mailing Address - Country:US
Mailing Address - Phone:404-425-8757
Mailing Address - Fax:
Practice Address - Street 1:1 W COURT SQ
Practice Address - Street 2:SUITE 750
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2538
Practice Address - Country:US
Practice Address - Phone:404-425-8757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
GA0051201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty