Organization
LIFE POURED OUT SERVICES, INC.
Active
Other names
Life Poured Out Services, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZETT DELICIA BLOUNT LPC (THERAPIST/CO-FOUNDER)
(718) 644-4998
Entity
Organization
Contact information
Practice address
3595 HIRAM DOUGLASVILLE HWY STE 108, HIRAM, GA 30141-4963
(770) 635-7847
(910) 516-1336
Mailing address
3595 HIRAM DOUGLASVILLE HWY STE 108, HIRAM, GA 30141-4963
(770) 635-7847
(910) 516-1336
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC011523
PROFESSIONAL
GA
Enumeration date
02/08/2021
Last updated
12/08/2021
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