Provider Demographics
NPI:1588295323
Name:STREAMS OF LIFE COUNSELING AND EDUCATIONAL SERVICES, LLC
Entity type:Organization
Organization Name:STREAMS OF LIFE COUNSELING AND EDUCATIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/THERAPIST - MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS-DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:404-388-7981
Mailing Address - Street 1:PO BOX 82653
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-9439
Mailing Address - Country:US
Mailing Address - Phone:404-388-7981
Mailing Address - Fax:
Practice Address - Street 1:990 IRIS DR SW STE 103
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6602
Practice Address - Country:US
Practice Address - Phone:770-369-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STREAMS OF LIFE COUNSELING AND EDUCATIONAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty