| Life Poured Out Services, Inc. | |
|
3595 Hiram Douglasville Hwy Ste 108 Hiram GA 30141-4963 | |
| (770) 635-7847 | |
| (910) 516-1336 |
| Full Name | Life Poured Out Services, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3595 Hiram Douglasville Hwy Ste 108, Hiram, Georgia |
| Authorized Official Name and Position | Suzett Delicia Blount (THERAPIST/CO-FOUNDER) |
| Authorized Official Contact | 7186444998 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Poured Out Services, Inc. 3595 Hiram Douglasville Hwy Ste 108 Hiram GA 30141-4963 Ph: (770) 635-7847 | Life Poured Out Services, Inc. 3595 Hiram Douglasville Hwy Ste 108 Hiram GA 30141-4963 Ph: (770) 635-7847 |
| NPI Number | 1174115539 |
|---|---|
| Provider Enumeration Date | 02/08/2021 |
| Last Update Date | 12/08/2021 |
| Certification Date | 12/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174115539 | NPI | - | NPPES |
| LPC011523 | Other | GA | PROFESSIONAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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