Provider Demographics
NPI:1104207836
Name:LIVING WELL MATTERS, LLC.
Entity Type:Organization
Organization Name:LIVING WELL MATTERS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONIFA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JEFFREY-RIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:443-845-3514
Mailing Address - Street 1:5730 COTTONWORTH AVE
Mailing Address - Street 2:UNIT 5389
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-7500
Mailing Address - Country:US
Mailing Address - Phone:443-845-3514
Mailing Address - Fax:
Practice Address - Street 1:512 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1947
Practice Address - Country:US
Practice Address - Phone:443-845-3514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MD123921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty