Provider Demographics
NPI:1649991589
Name:BALANCING LIFE PSYCHOLOGY
Entity type:Organization
Organization Name:BALANCING LIFE PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMOIRI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:404-936-9455
Mailing Address - Street 1:PO BOX 6181
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30065-0181
Mailing Address - Country:US
Mailing Address - Phone:404-936-9455
Mailing Address - Fax:
Practice Address - Street 1:2695 SUGARLOAF PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-9456
Practice Address - Country:US
Practice Address - Phone:404-936-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty