Provider Demographics
NPI:1366827073
Name:HEALTHY LIVES, LLC
Entity Type:Organization
Organization Name:HEALTHY LIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LCADC
Authorized Official - Phone:443-722-3116
Mailing Address - Street 1:1001 PINE HEIGHTS AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5202
Mailing Address - Country:US
Mailing Address - Phone:443-219-7901
Mailing Address - Fax:443-835-2521
Practice Address - Street 1:1001 PINE HEIGHTS AVE STE 303
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5202
Practice Address - Country:US
Practice Address - Phone:443-219-7901
Practice Address - Fax:443-835-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD905711251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health