Provider Demographics
NPI:1538671581
Name:TRANQUIL LIFE COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:TRANQUIL LIFE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOALENZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-896-8959
Mailing Address - Street 1:1899 LAKE RD STE 123
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-6006
Mailing Address - Country:US
Mailing Address - Phone:678-896-8959
Mailing Address - Fax:678-550-1155
Practice Address - Street 1:1899 LAKE RD STE 123
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-6006
Practice Address - Country:US
Practice Address - Phone:678-896-8959
Practice Address - Fax:678-550-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty