Lifestyle Therapy Center, LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC008361 Issued in GA

Legal business name

LIFESTYLE THERAPY CENTER, LLC

Practice address

150 Medical Way
Suite F1
Riverdale, GA 30274-2533

Phone

(404) 709-8373

NPI assigned

Jan 8, 2016

Organization subpart

No

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

Authorized official

Name

Amanda Holloway

Title

LPC

Phone

(404) 709-8373

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1780040576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MEDICAL WAY",
            "address_2": "SUITE F1",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MEDICAL WAY",
            "address_2": "SUITE F1",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742533",
            "telephone_number": "404-709-8373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-08",
        "last_updated": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "HOLLOWAY",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "LPC",
        "authorized_official_telephone_number": "404-709-8373"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC008361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSN",
            "identifier": "$$$$$$$$$",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; 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.