Village Life,LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

CSW005893 Issued in GA

Legal business name

VILLAGE LIFE,LLC

Practice address

569 Granite CT
Lawrenceville, GA 30044-6931

Phone

(404) 353-2227

NPI assigned

Oct 25, 2016

Organization subpart

No

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

Authorized official

Name

Mia Garret, LCSW

Title

Founder/Program Developer

Phone

(404) 353-2227

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1487106563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "569 GRANITE CT",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300446931",
            "telephone_number": "404-353-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "569 GRANITE CT",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300446931",
            "telephone_number": "404-353-2227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE LIFE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-25",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "GARRET",
        "authorized_official_first_name": "MIA",
        "authorized_official_title_or_position": "FOUNDER/PROGRAM DEVELOPER",
        "authorized_official_telephone_number": "404-353-2227",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "CSW005893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.