Provider Demographics
NPI:1063873396
Name:REAL LIFE SOLUTIONS GA
Entity type:Organization
Organization Name:REAL LIFE SOLUTIONS GA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-920-7272
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133-0641
Mailing Address - Country:US
Mailing Address - Phone:770-927-7272
Mailing Address - Fax:
Practice Address - Street 1:8355 CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2591
Practice Address - Country:US
Practice Address - Phone:770-927-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005654251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health