Provider Demographics
NPI:1295267268
Name:HEALTHY LIFE COUNSELING
Entity type:Organization
Organization Name:HEALTHY LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-752-4335
Mailing Address - Street 1:2521 MOUNTAIN VIEW RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5829
Mailing Address - Country:US
Mailing Address - Phone:678-752-4335
Mailing Address - Fax:678-649-2101
Practice Address - Street 1:2521 MOUNTAIN VIEW RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5829
Practice Address - Country:US
Practice Address - Phone:678-752-4335
Practice Address - Fax:678-649-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009255261QM0801X, 261QM0855X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health