Provider Demographics
NPI:1629323415
Name:BUILDING BOLCKS 4 LIFE
Entity Type:Organization
Organization Name:BUILDING BOLCKS 4 LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ENDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-889-1815
Mailing Address - Street 1:970 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6988
Mailing Address - Country:US
Mailing Address - Phone:678-889-1815
Mailing Address - Fax:678-889-1764
Practice Address - Street 1:970 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6988
Practice Address - Country:US
Practice Address - Phone:678-889-1815
Practice Address - Fax:678-889-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty