11D2247629 CLIA NUMBER - LIFE CHANGES COUNSELING AND CONSULTING SVCS

Laboratory Demographics

  • CLIA Code: 11D2247629
  • Facility Name: LIFE CHANGES COUNSELING AND CONSULTING SVCS
  • Facility Address: 1003 VIRGINIA AVENUE, SUITE 104
    ATLANTA, GA
    ZIP 30354
  • Facility Phone: 404 500-1994
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TERENCE T. WILKINS
  • NPI Number: 1407467434
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 11D2247629
LAB Type Practitioner Other
Facility Name LIFE CHANGES COUNSELING AND CONSULTING SVCS
Street 1003 VIRGINIA AVENUE, SUITE 104
City ATLANTA
State GA
ZIP 30354
Phone 404 500-1994
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2024
Certificate Expiration Date 1/6/2026
Facility Type Practitioner Other
Lab Director TERENCE T. WILKINS

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This page was last updated on: 9/29/2025