Provider Demographics
NPI:1225702657
Name:LIVE OAK COUNSELING AND ASSOCIATES
Entity Type:Organization
Organization Name:LIVE OAK COUNSELING AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:910-538-4397
Mailing Address - Street 1:33 PELICAN POINT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-3567
Mailing Address - Country:US
Mailing Address - Phone:910-538-4397
Mailing Address - Fax:
Practice Address - Street 1:3806 PARK AVE STE D
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6739
Practice Address - Country:US
Practice Address - Phone:910-636-5100
Practice Address - Fax:910-636-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty