LIFESTYLE THERAPY CENTER, LLC (NPI# 1780040576) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780040576 |
| Entity Type | Organization |
| Organization Name | LIFESTYLE THERAPY CENTER, LLC |
| Practice Address |
150 Medical Way Suite F1 Riverdale GA 30274-2533 |
| Practice Telephone | 4047098373 |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2020-05-21 |
| Authorized Official Name | AMANDA HOLLOWAY (LPC) |
| Authorized Official Telephone | 4047098373 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YP2500X |
Counselor Specialization: Professional |
LPC008361 | GA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | SSN | $$$$$$$$$ | 01 |
| Street Address |
150 MEDICAL WAY SUITE F1 |
| City | RIVERDALE |
| State | GA |
| Zip Code | 30274-2533 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427000777 | Benchmark Physical Therapy Inc | Occupational Therapist | 150 Medical Way, Suite E1, Riverdale, GA 30274-2533 | 2006-05-16 |
| 1114385598 | Amanda Holloway | Counselor | 150 Medical Way, Riverdale, GA 30274-2533 | 2016-02-01 |
| 1265813059 | Amber Thomas Burns | Physical Therapist | 150 Medical Way, Ste E1, Riverdale, GA 30274-2533 | 2015-06-17 |
| 1396154837 | Maria Anjanette Costales Nunez | Physical Therapist | 150 Medical Way, Ste E1, Riverdale, GA 30274-2533 | 2014-08-08 |
| 1598196198 | Myron Javon Falkner | Nurse Practitioner | 150 Medical Way, Suite F, Riverdale, GA 30274 | 2013-12-06 |
| 1356624910 | Traci Pope Jordan | Physical Therapist | 150 Medical Way, Ste E1, Riverdale, GA 30274-2533 | 2011-09-21 |
| 1710122031 | Michael Harris | Physical Therapist | 150 Medical Way, Suite E1, Riverdale, GA 30274-2533 | 2008-12-16 |
| 1184844102 | Cameron Dewitt Barham | Physical Therapist | 150 Medical Way, Ste E1, Riverdale, GA 30274-2533 | 2007-05-01 |
| 1154467991 | Sadrudin J Sarangi | Internal Medicine | 150 Medical Way, Suite B - 1, Riverdale, GA 30274-2533 | 2007-01-29 |
| 1801942685 | Sadrudin J Sarangi, M D, P C | Internal Medicine | 150 Medical Way, Suite B - 1, Riverdale, GA 30274-2533 | 2007-01-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245862507 | Todd L. Reed | Chiropractor | 83 Upper Riverdale Rd, Riverdale, GA 30274 | 2020-02-05 |
| 1487135992 | Freddie L Sallette IIi | Technician, Pathology | 385 Brookview Dr, Riverdale, GA 30274 | 2018-08-22 |
| 1366933210 | Dawn A. Paul | Nurse Practitioner | 238 Professional Ct Ste A, Riverdale, GA 30274 | 2018-05-27 |
| 1851894588 | Absolute Health Family & Urgent Care Clinic | Clinic/Center | 7574 Ga 85, Riverdale, GA 30274 | 2018-03-08 |
| 1366972127 | Jamillah Ingram | Physical Therapy Assistant | 315 Upper Riverdale Rd., Riverdale, GA 30274 | 2017-06-14 |
| 1114456514 | Grace L Kelson | Licensed Practical Nurse | 9142 Clubhouse Dr, Riverdale, GA 30274 | 2017-06-08 |
| 1790167799 | Cristian Carbuccia | Internal Medicine | 33 Upper Riverdale Rd Sw Ste 10, Riverdale, GA 30274 | 2015-06-25 |
| 1265857692 | Right Choice Enterprises LLC | Technician | 638 Sterling Ct, Riverdale, GA 30274 | 2014-02-21 |
| 1942571625 | Lowes Guardian Angel LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7056 Eunice Dr., Riverdale, GA 30274 | 2012-01-26 |
| 1508134156 | Education System Management, Inc | Social Worker | 125 Highway 138, Riverdale, GA 30274 | 2011-12-12 |
| Find all providers in zip 30274 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801414578 | Keva Ellis | Counselor | 6815 W Fayetteville Rd, Riverdale, GA 30296-2528 | 2020-07-09 |
| 1346886686 | Jeremiah Johnson | Counselor | 7430 Royale Ln, Riverdale, GA 30296-7223 | 2019-11-21 |
| 1841835600 | Jernica Mcneil | Counselor | 7237 Mockingbird Trl, Riverdale, GA 30274-3732 | 2019-11-15 |
| 1134779366 | Kristol Daley | Counselor | 1343 E Fayetteville Rd, Riverdale, GA 30296-3101 | 2019-09-19 |
| 1104287606 | Luciana Renea Wright | Counselor | 6373 Bell Haven Ln, Riverdale, GA 30296-2553 | 2016-03-10 |
| 1285023457 | Shalette Lawton | Counselor | 150 Medical Way Suite F1, Riverdale, GA 30274-3027 | 2015-01-12 |
| 1639406945 | Martalyn Grace Stephens-billingsley | Counselor | 7000 Kimberly Ln, Riverdale, GA 30296-2000 | 2009-11-06 |
| 1942432885 | Waikiki L Upshaw | Counselor | 286 Highway 138 Sw, Suite E, Riverdale, GA 30274-4010 | 2009-08-11 |
| 1417112749 | Thomas A Parker | Counselor | 1999 Levgard Ln, Riverdale, GA 30296-2427 | 2008-07-25 |
| 1205099926 | Juanita M. Dunn | Counselor | 302 W 145th St, Riverdale, IL 60827-2711 | 2008-07-02 |
| Find all providers in RIVERDALE | ||||
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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.