Provider Demographics
NPI:1609426360
Name:LIVING WELL COUNSELING, LLC
Entity Type:Organization
Organization Name:LIVING WELL COUNSELING, LLC
Other - Org Name:LIVING WELL COUNSELING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TALISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TELSEE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:803-250-1152
Mailing Address - Street 1:500 HARBISON BLVD APT 505
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1718
Mailing Address - Country:US
Mailing Address - Phone:803-543-5481
Mailing Address - Fax:
Practice Address - Street 1:6156 SAINT ANDREWS RD STE 105
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3147
Practice Address - Country:US
Practice Address - Phone:803-250-1152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)