Provider Demographics
NPI:1619349107
Name:LIVING WELL BEHAVIORAL HEALTH LAB
Entity Type:Organization
Organization Name:LIVING WELL BEHAVIORAL HEALTH LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-803-2111
Mailing Address - Street 1:2350 BENTRIDGE LN STE 301A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0590
Mailing Address - Country:US
Mailing Address - Phone:910-748-0261
Mailing Address - Fax:910-758-9358
Practice Address - Street 1:2350 BENTRIDGE LN STE 301A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-0590
Practice Address - Country:US
Practice Address - Phone:910-748-0261
Practice Address - Fax:910-758-9358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING WELL BEHAVIORAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-23
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory