| Total Life Wellness Llc | |
|
4566 Lawrenceville Hwy Nw Ste 101 Lilburn GA 30047-3686 | |
| (877) 935-5285 | |
| Not Available |
| Full Name | Total Life Wellness Llc |
|---|---|
| Speciality | Psychologist |
| Location | 4566 Lawrenceville Hwy Nw Ste 101, Lilburn, Georgia |
| Authorized Official Name and Position | Frederick Warren (CEO) |
| Authorized Official Contact | 7703650043 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Total Life Wellness Llc 4159 Yearling Way Lithonia GA 30038-6138 Ph: (877) 935-5285 | Total Life Wellness Llc 4566 Lawrenceville Hwy Nw Ste 101 Lilburn GA 30047-3686 Ph: (877) 935-5285 |
| NPI Number | 1093411464 |
|---|---|
| Provider Enumeration Date | 02/06/2023 |
| Last Update Date | 04/13/2023 |
| Certification Date | 04/13/2023 |
| Medicare PECOS PAC ID | 4082089602 |
|---|---|
| Medicare Enrollment ID | O20230413001916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093411464 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Tia L Thomas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194061770 PECOS PAC ID: 8921246851 Enrollment ID: I20230414000430 |
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