Provider Demographics
NPI:1003678186
Name:LIVING COLOR WELLNESS LLC
Entity Type:Organization
Organization Name:LIVING COLOR WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:I
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PMH-C
Authorized Official - Phone:312-972-8605
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-0645
Mailing Address - Country:US
Mailing Address - Phone:312-972-8605
Mailing Address - Fax:
Practice Address - Street 1:14958 W CYRUS DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-7749
Practice Address - Country:US
Practice Address - Phone:312-972-8605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty