Provider Demographics
NPI:1174982474
Name:GENESIS OF LIFE INC
Entity type:Organization
Organization Name:GENESIS OF LIFE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSELY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-604-0544
Mailing Address - Street 1:316 ALEXANDER ST SE
Mailing Address - Street 2:STE 2
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8217
Mailing Address - Country:US
Mailing Address - Phone:404-604-0544
Mailing Address - Fax:404-585-4421
Practice Address - Street 1:316 ALEXANDER ST SE
Practice Address - Street 2:STE 2
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8217
Practice Address - Country:US
Practice Address - Phone:404-604-0544
Practice Address - Fax:404-585-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty