Provider Demographics
NPI:1144548033
Name:BALANCED LIFE COUNSELING, LLC
Entity type:Organization
Organization Name:BALANCED LIFE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGNER-KLEINE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:404-276-5933
Mailing Address - Street 1:3040 GOLDMIST DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7821
Mailing Address - Country:US
Mailing Address - Phone:404-276-5933
Mailing Address - Fax:404-585-5004
Practice Address - Street 1:4305 S LEE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-5783
Practice Address - Country:US
Practice Address - Phone:404-276-5933
Practice Address - Fax:404-585-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001076251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health