Provider Demographics
NPI:1578728671
Name:LIFE CHANGERS COMMUNITY EMPOWERMENT ENTERPRISES, INC
Entity Type:Organization
Organization Name:LIFE CHANGERS COMMUNITY EMPOWERMENT ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-399-6136
Mailing Address - Street 1:7098 SIR CHARLES CT
Mailing Address - Street 2:SUTE A
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3236
Mailing Address - Country:US
Mailing Address - Phone:404-399-6136
Mailing Address - Fax:
Practice Address - Street 1:7098 SIR CHARLES CT
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3236
Practice Address - Country:US
Practice Address - Phone:404-399-6136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty