Provider Demographics
NPI:1225795214
Name:LIVE WELL COUNSELING AND TRAINING
Entity Type:Organization
Organization Name:LIVE WELL COUNSELING AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-206-7435
Mailing Address - Street 1:15 SEA SOUNDS AVE
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1018
Mailing Address - Country:US
Mailing Address - Phone:609-206-7435
Mailing Address - Fax:
Practice Address - Street 1:505 NEW RD STE 3
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2049
Practice Address - Country:US
Practice Address - Phone:609-206-7435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty