CENTER FOR AUTHENTIC LIFE & RELATIONSHIP, LLC (NPI# 1366906778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366906778 |
| Entity Type | Organization |
| Organization Name | CENTER FOR AUTHENTIC LIFE & RELATIONSHIP, LLC |
| Practice Address |
1426 Olde Forge Ln Woodstock GA 30189-1553 |
| Practice Telephone | 6785166902 |
| Mailing Telephone | 6785166902 |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2019-01-30 |
| Authorized Official Name | MR. ROY ALIN BLANKENSHIP (MANAGING PARTNER) |
| Authorized Official Telephone | 6785166902 |
| Authorized Official Credential | LPC, LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Street Address |
1426 OLDE FORGE LN |
| City | WOODSTOCK |
| State | GA |
| Zip Code | 30189-1553 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801494356 | Susan Iruku | Pharmacist | 12050 Ga-92 #112, Woodstock, GA 30189 | 2020-10-15 |
| 1598267437 | Kelly Sierra | Nurse Practitioner | 100 Stoneforest Dr Ste 300, Woodstock, GA 30189 | 2018-03-07 |
| 1548770449 | Chandra Johnson | Nurse Practitioner | 295 Molly Lane Ste 150, Woodstock, GA 30189 | 2017-10-05 |
| 1083133912 | Amanda Bostock Sowisdral | Physician Assistant | 250 Parkbrooke Pl Ste 300, Woodstock, GA 30189 | 2017-09-12 |
| 1780101659 | Laura C Koch Woodstock LLC Dba Fountain View Dentistry | Dentist | 1816 Eagle Drive, Building 200-a, Woodstock, GA 30189 | 2017-08-23 |
| 1265954788 | Vicky Morton Bryan | Nurse Practitioner | 422 Sycamore Trail, Woodstock, GA 30189 | 2017-07-17 |
| 1063933588 | Marietta Eye Clinic, Pa | Optometrist | 2990 Eagle Dr Ste 110, Woodstock, GA 30189 | 2017-07-06 |
| 1275914749 | Nrup Tolat | Podiatrist | 100 Stoneforest Dr Ste 120, Woodstock, GA 30189 | 2015-06-10 |
| 1558781534 | Mary Jansson Carmon | Nurse Practitioner | 1000 Towne Lake Pkwy, Woodstock, GA 30189 | 2014-04-17 |
| 1518388941 | Afc Physicians of Georgia, PC | General Practice | 6440 Bells Ferry Rd, Woodstock, GA 30189 | 2014-01-03 |
| Find all providers in zip 30189 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| 1912551490 | Next Level Counseling and Wellness LLC | Clinic/Center | 226 W Judd St, Woodstock, IL 60098-3158 | 2019-08-01 |
| 1295215606 | Flow of Wellness LLC | Clinic/Center | 205 River Park North Dr, Woodstock, GA 30188-7835 | 2018-08-15 |
| 1952890105 | Rose Kihara Nurse Practitioner LLC | Clinic/Center | 39 Route 171, Woodstock, CT 06281 | 2018-05-03 |
| 1508387978 | Association for Individual Development | Clinic/Center | 109 S Jefferson St, Woodstock, IL 60098-3465 | 2017-07-06 |
| Find all providers in WOODSTOCK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.