| Lifestyle Therapy Center, Llc | |
|
150 Medical Way Suite F1 Riverdale GA 30274-2533 | |
| (404) 709-8373 | |
| Not Available |
| Full Name | Lifestyle Therapy Center, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 150 Medical Way, Riverdale, Georgia |
| Authorized Official Name and Position | Amanda Holloway (LPC) |
| Authorized Official Contact | 4047098373 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifestyle Therapy Center, Llc 150 Medical Way Suite F1 Riverdale GA 30274-2533 Ph: () - | Lifestyle Therapy Center, Llc 150 Medical Way Suite F1 Riverdale GA 30274-2533 Ph: (404) 709-8373 |
| NPI Number | 1780040576 |
|---|---|
| Provider Enumeration Date | 01/08/2016 |
| Last Update Date | 05/21/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780040576 | NPI | - | NPPES |
| $$$$$$$$$ | Other | GA | SSN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC008361 (Georgia) | Primary |
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