Provider Demographics
NPI:1609215250
Name:LIVEWELL COUNSELING GROUP
Entity Type:Organization
Organization Name:LIVEWELL COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-536-9050
Mailing Address - Street 1:9536 LINGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1870
Mailing Address - Country:US
Mailing Address - Phone:321-209-9534
Mailing Address - Fax:407-286-6133
Practice Address - Street 1:9536 LINGWOOD TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1870
Practice Address - Country:US
Practice Address - Phone:321-209-9534
Practice Address - Fax:407-286-6133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty