Provider Demographics
NPI:1710263306
Name:LIVING TO BE FREE, PLLC
Entity Type:Organization
Organization Name:LIVING TO BE FREE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:910-315-4909
Mailing Address - Street 1:4415 MURDOCKSVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST END
Mailing Address - State:NC
Mailing Address - Zip Code:27376
Mailing Address - Country:US
Mailing Address - Phone:910-315-4909
Mailing Address - Fax:910-420-2202
Practice Address - Street 1:4415 MURDOCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST END
Practice Address - State:NC
Practice Address - Zip Code:27376-8899
Practice Address - Country:US
Practice Address - Phone:910-315-4909
Practice Address - Fax:910-420-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8093251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104605Medicaid