Provider Demographics
NPI:1487846697
Name:THE LIVE OAK CENTER, LLC
Entity Type:Organization
Organization Name:THE LIVE OAK CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EPTING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-661-3162
Mailing Address - Street 1:10 CHESTLEY PL
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4200
Mailing Address - Country:US
Mailing Address - Phone:912-661-3162
Mailing Address - Fax:
Practice Address - Street 1:8 COMMERCE PL
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3615
Practice Address - Country:US
Practice Address - Phone:912-661-3162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty