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Organization
THE LIFE SOURCE GROUP INC
Active
Organization
THE LIFE SOURCE GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LATEASHA SKINNER LPC (OWNER)
(706) 984-0215
Entity
Organization
Contact information
Practice address
1425 WYNNTON RD STE A, COLUMBUS, GA 31906-5718
(706) 984-0215
Mailing address
1425 WYNNTON RD STE A, COLUMBUS, GA 31906-5718
(334) 984-0215
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
104100000X
Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
01/07/2025
Last updated
01/07/2025
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