Provider Demographics
NPI:1942509096
Name:LIVE LIFE NOW
Entity type:Organization
Organization Name:LIVE LIFE NOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHABILITATION COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:FELICIA
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CRC
Authorized Official - Phone:404-396-4979
Mailing Address - Street 1:192 OAKLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-4462
Mailing Address - Country:US
Mailing Address - Phone:404-396-4979
Mailing Address - Fax:
Practice Address - Street 1:192 OAKLEIGH LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4462
Practice Address - Country:US
Practice Address - Phone:404-396-4979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00073318251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health