Living Balance Psychotherapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

LIVING BALANCE PSYCHOTHERAPY LLC

Practice address

2810 Peachtree Industrial Blvd Ste D
Duluth, GA 30097-8142

Phone

(404) 919-8496

NPI assigned

Nov 2, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ann Gillman, LCSWNPI 1407588122

Title

Co-Owner

Phone

(404) 919-8496

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ann Gillman, LCSW

  • Clinical Social Worker
  • Berkeley Lake, GA
  • NPI 1407588122
  Medicare reassignment NPD Authorized official
• Kathryn Hendley, LMSW

  • Social Worker
  • Duluth, GA
  • NPI 1073204111
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1265149835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3470 MCCLURE BRIDGE RD UNIT 2511",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300961125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 PEACHTREE INDUSTRIAL BLVD STE D",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300978142",
            "telephone_number": "404-919-8496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING BALANCE PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-02",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "GILLMAN",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "404-919-8496",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Duluth, GA
• Providers in Duluth, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.