Provider Demographics
NPI:1114680519
Name:LIFE WISDOM COUNSELING LLC
Entity Type:Organization
Organization Name:LIFE WISDOM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRETH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:770-540-7531
Mailing Address - Street 1:2045 CACTUS LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-4484
Mailing Address - Country:US
Mailing Address - Phone:770-540-7531
Mailing Address - Fax:
Practice Address - Street 1:327 DAHLONEGA ST STE B1703
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8207
Practice Address - Country:US
Practice Address - Phone:770-540-7531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty