11D2276494 CLIA NUMBER - LIFESTANCE HEALTH

Laboratory Demographics

CLIA Number: 11D2276494

Facility Name: LIFESTANCE HEALTH

Facility Address:
850 MAYFIELD ROAD, SUITE #203
ALPHARETTA, GA
ZIP 30009
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Facility Phone Number: 470 805-5040

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558099192

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name	Field Value
CLIA Number	11D2276494
LAB Type	Physician Office
Facility Name	LIFESTANCE HEALTH
Street	850 MAYFIELD ROAD, SUITE #203
City	ALPHARETTA
State	GA
ZIP	30009
Phone	470 805-5040
CertificateType	4
CertificateEffectiveDate	2/9/2023
CertificateExpirationDate	2/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024