Provider Demographics
NPI:1437531043
Name:LIVING ANEW WELLNESS CENTER, PLLC
Entity Type:Organization
Organization Name:LIVING ANEW WELLNESS CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:STATEN
Authorized Official - Last Name:DRAKEFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCASA, CCDVC
Authorized Official - Phone:910-728-5980
Mailing Address - Street 1:PO BOX 42242
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-2242
Mailing Address - Country:US
Mailing Address - Phone:910-578-0232
Mailing Address - Fax:910-705-8447
Practice Address - Street 1:1830 OWEN DR
Practice Address - Street 2:SUITE 10
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-1611
Practice Address - Country:US
Practice Address - Phone:910-745-8712
Practice Address - Fax:910-705-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11591251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health