Provider Demographics
NPI:1992127518
Name:THE BLISS CENTER, PARACLETOS INSTITUTE INTERNATIONAL
Entity type:Organization
Organization Name:THE BLISS CENTER, PARACLETOS INSTITUTE INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEHOME'
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-522-5361
Mailing Address - Street 1:109 N 85 PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4003
Mailing Address - Country:US
Mailing Address - Phone:770-731-0564
Mailing Address - Fax:770-731-0564
Practice Address - Street 1:109 N 85 PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4003
Practice Address - Country:US
Practice Address - Phone:770-731-0564
Practice Address - Fax:770-731-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170724302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization