Provider Demographics
NPI:1881013340
Name:DESIGN Y LIFE
Entity Type:Organization
Organization Name:DESIGN Y LIFE
Other - Org Name:THE MENTORING PROJECT FOR FAMILIES CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-267-1488
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-0428
Mailing Address - Country:US
Mailing Address - Phone:706-267-1488
Mailing Address - Fax:706-592-9247
Practice Address - Street 1:540 BASIN ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3834
Practice Address - Country:US
Practice Address - Phone:706-267-1488
Practice Address - Fax:706-592-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15458417251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health