Provider Demographics
NPI:1578961439
Name:LIFE CHANGING SOLUTIONS, LLC
Entity Type:Organization
Organization Name:LIFE CHANGING SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:318-213-0904
Mailing Address - Street 1:PO BOX 1792
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71166-1792
Mailing Address - Country:US
Mailing Address - Phone:318-213-0904
Mailing Address - Fax:318-213-0905
Practice Address - Street 1:5825 LIVE OAK PKWY
Practice Address - Street 2:SUITE 2B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1728
Practice Address - Country:US
Practice Address - Phone:470-719-0944
Practice Address - Fax:470-275-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health