Organization
MISTER LIFE COACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT GREEN (LIFE COACH)
(631) 553-7131
Entity
Organization
Contact information
Practice address
3681 N DECATUR RD APT R11, DECATUR, GA 30032-1062
(631) 553-7131
Mailing address
PO BOX 283, REX, GA 30273-0283
(631) 553-7131
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
GA
Other
Enumeration date
04/25/2017
Last updated
04/25/2017
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