Provider Demographics
NPI:1104175207
Name:A LIFE AWARE YOGA AND WELLNESS
Entity type:Organization
Organization Name:A LIFE AWARE YOGA AND WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:YOGA THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RYT
Authorized Official - Phone:404-316-8329
Mailing Address - Street 1:18245 CHERRYLAWN
Mailing Address - Street 2:
Mailing Address - City:DETROT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2013
Mailing Address - Country:US
Mailing Address - Phone:404-316-8329
Mailing Address - Fax:
Practice Address - Street 1:18245 CHERRYLAWN
Practice Address - Street 2:
Practice Address - City:DETROT
Practice Address - State:MI
Practice Address - Zip Code:48221-2013
Practice Address - Country:US
Practice Address - Phone:404-316-8329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty