Provider Demographics
NPI:1063010775
Name:LIVEWELL THERAPY, LLC
Entity Type:Organization
Organization Name:LIVEWELL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-464-8420
Mailing Address - Street 1:13926 HULL STREET RD # 2025
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2004
Mailing Address - Country:US
Mailing Address - Phone:804-464-8420
Mailing Address - Fax:
Practice Address - Street 1:221 RUTHERS RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5395
Practice Address - Country:US
Practice Address - Phone:804-464-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty