Provider Demographics
NPI:1780821306
Name:AUTHENTIC LIVING
Entity Type:Organization
Organization Name:AUTHENTIC LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-296-5300
Mailing Address - Street 1:1110 ROSE HILL DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903
Mailing Address - Country:US
Mailing Address - Phone:434-296-5300
Mailing Address - Fax:434-984-2464
Practice Address - Street 1:1110 ROSE HILL DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903
Practice Address - Country:US
Practice Address - Phone:434-296-5300
Practice Address - Fax:434-984-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003549101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty