Organization
L.I.F.E. CS-CSI DIVISION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA KAY THOMPSON-LISIECKI LPC (OWNER)
(912) 496-2616
Entity
Organization
Contact information
Practice address
710 BOWERY LN, BLDG.G BOX # 41, FOLKSTON, GA 31537-5967
(912) 496-2616
(912) 496-0817
Mailing address
710 BOWERY LN, BLDG.G BOX # 41, FOLKSTON, GA 31537-5967
(912) 496-2616
(912) 496-0817
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
045321
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193400000X
—
GA
Enumeration date
11/09/2012
Last updated
04/10/2015
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