Provider Demographics
NPI:1619600178
Name:UPLIFTED LIVING, LLC
Entity Type:Organization
Organization Name:UPLIFTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIROTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-376-1104
Mailing Address - Street 1:3654 S MARLBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8313
Mailing Address - Country:US
Mailing Address - Phone:404-376-1104
Mailing Address - Fax:
Practice Address - Street 1:3654 S MARLBOROUGH DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8313
Practice Address - Country:US
Practice Address - Phone:404-376-1104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty