NPIMap

Organization Active NPI

The Life Change Group

  • Counseling Psychologist
  • Peachtree City, GA
National Provider Identifier
1790159598
Registry record updated Nov 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
PSY003202 Issued in GA
Legal business name
THE LIFE CHANGE GROUP
Practice address
302 Stevens Entry
Peachtree City, GA 30269-1325
Phone
(770) 486-4887
NPI assigned
Nov 18, 2015
Last updated
Nov 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2015

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

Authorized official

Name
Pamela M Wright, PH DNPI 1023197936
Title
Licensed Psychologist
Phone
(770) 486-4887

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X PSY003202 GA Primary

Addresses

Primary practice location

302 Stevens Entry
Peachtree City, GA 30269-1325

Mailing address

590 Wentworth CT
Fayetteville, GA 30215-7830
Phone (404) 664-5797

National Provider Directory

National Provider Directory

Locations

302 Stevens Entry
Peachtree City, GA 30269
Phone (770) 486-4887

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447804800000",
    "number": "1790159598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 WENTWORTH CT",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302157830",
            "telephone_number": "404-664-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 STEVENS ENTRY",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691325",
            "telephone_number": "770-486-4887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIFE CHANGE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-18",
        "last_updated": "2015-11-18",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "770-486-4887",
        "authorized_official_credential": "PH D"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "GA",
            "license": "PSY003202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; 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.