Provider Demographics
NPI:1124329446
Name:LIFE CLARITY GROUP
Entity type:Organization
Organization Name:LIFE CLARITY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:404-857-7152
Mailing Address - Street 1:3375 CENTERVILLE HWY
Mailing Address - Street 2:#391711
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-0133
Mailing Address - Country:US
Mailing Address - Phone:404-857-7152
Mailing Address - Fax:
Practice Address - Street 1:2336 WISTERIA DR
Practice Address - Street 2:SUITE 410
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6191
Practice Address - Country:US
Practice Address - Phone:404-857-7152
Practice Address - Fax:404-478-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003122445AMedicaid