Provider Demographics
NPI:1053978700
Name:LIFE TOOLS COMMUNITY DEVELOPMENT CORPORATION
Entity type:Organization
Organization Name:LIFE TOOLS COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BONICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-942-4742
Mailing Address - Street 1:5357 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5027
Mailing Address - Country:US
Mailing Address - Phone:770-942-4742
Mailing Address - Fax:770-293-0786
Practice Address - Street 1:5357 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-5027
Practice Address - Country:US
Practice Address - Phone:770-942-4742
Practice Address - Fax:770-293-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty