Provider Demographics
NPI:1417216979
Name:LIFEWORKS WELLNESS,LLC
Entity Type:Organization
Organization Name:LIFEWORKS WELLNESS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-772-1161
Mailing Address - Street 1:2515 BRADFORD SQ NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1338
Mailing Address - Country:US
Mailing Address - Phone:678-772-1161
Mailing Address - Fax:
Practice Address - Street 1:3355 LENOX RD NE
Practice Address - Street 2:STE 750
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1394
Practice Address - Country:US
Practice Address - Phone:678-772-1161
Practice Address - Fax:404-504-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW002791251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health