Organization · NPI-2

Life Enrichment And Wellness Services

Community/Behavioral Health · Loganville, GA

NPI number1295158699
StatusActive
Last updated in NPPESJan 22, 2014

Details

NPI
1295158699
Entity type
Organization (NPI-2)
Legal business name
Life Enrichment And Wellness Services
Organization subpart
Yes
Enumeration date
Jan 22, 2014
Last updated
Jan 22, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
251S00000X Community/Behavioral Healthga006581GAYes

Other names

  • Life Link Of Louisiana (Other Name)

Practice location

608 Stonecrest Drive
Loganville, GA 30052

Phone 678-949-3184

Mailing address

608 Stonecrest Drive
Loganville, GA 30052

Phone 678-949-3184

Authorized official

Carlos Porter
Owner
6789493184

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