Provider Demographics
NPI:1457876906
Name:THE CENTER FOR LIVING BALANCE, INC
Entity Type:Organization
Organization Name:THE CENTER FOR LIVING BALANCE, INC
Other - Org Name:AMY JAYNES COUNSELING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:FOWLER
Authorized Official - Last Name:JAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC, CRC
Authorized Official - Phone:770-451-0404
Mailing Address - Street 1:130 GOVERNORS SQ STE B
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4862
Mailing Address - Country:US
Mailing Address - Phone:770-451-0404
Mailing Address - Fax:770-451-0404
Practice Address - Street 1:130 GOVERNORS SQ STE B
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4862
Practice Address - Country:US
Practice Address - Phone:770-451-0404
Practice Address - Fax:770-451-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty