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Organization
MAXLIFE THERAPEUTIC SOLUTIONS INC
Active
Organization
MAXLIFE THERAPEUTIC SOLUTIONS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN WALLER (CHIEF EXECUTIVE OFFICER)
(404) 867-3093
Entity
Organization
Contact information
Practice address
204B PITCARIN WAY, SUITE #1, AUGUSTA, GA 30909-5766
(912) 319-7250
Mailing address
3915 CASCADE RD SW STE 355, ATLANTA, GA 30331-8520
(404) 867-3093
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
04/12/2016
Last updated
04/12/2016
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