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Organization
LIVE WELL BEHAVIORAL MEDICINE P.C.
Active
Organization
LIVE WELL BEHAVIORAL MEDICINE P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMARRI ROLLOCKS LPC (OWNER)
(404) 944-9425
Entity
Organization
Contact information
Practice address
4390 EARNEY RD STE 140, WOODSTOCK, GA 30188-5687
(678) 568-2285
(706) 553-4157
Mailing address
1290 KENNESTONE CIR STE D109, MARIETTA, GA 30066-6097
(404) 944-9425
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/12/2022
Last updated
09/12/2022
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