Organization
LIFESTYLE THERAPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA HOLLOWAY (LPC)
(404) 709-8373
Entity
Organization
Contact information
Practice address
150 MEDICAL WAY, SUITE F1, RIVERDALE, GA 30274-2533
(404) 709-8373
Mailing address
150 MEDICAL WAY, SUITE F1, RIVERDALE, GA 30274-2533
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC008361
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SSN
GA
Enumeration date
01/08/2016
Last updated
05/21/2020
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