Provider Demographics
NPI:1285024810
Name:LIFE TRANSFORMATION PSYCHOLOGICAL CENTER, PC
Entity Type:Organization
Organization Name:LIFE TRANSFORMATION PSYCHOLOGICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:706-530-1504
Mailing Address - Street 1:950 HERRINGTON RD
Mailing Address - Street 2:SUITE C 186
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7217
Mailing Address - Country:US
Mailing Address - Phone:706-530-1504
Mailing Address - Fax:
Practice Address - Street 1:1755 N BROWN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8198
Practice Address - Country:US
Practice Address - Phone:706-530-1504
Practice Address - Fax:855-420-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003783103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty