Provider Demographics
NPI:1790238335
Name:LIVING WELL BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:LIVING WELL BEHAVIORAL HEALTH, INC.
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:910-565-2322
Mailing Address - Street 1:2350 BENTRIDGE LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0590
Mailing Address - Country:US
Mailing Address - Phone:910-565-2322
Mailing Address - Fax:910-479-1401
Practice Address - Street 1:2350 BENTRIDGE LN
Practice Address - Street 2:SUITE 300
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-0590
Practice Address - Country:US
Practice Address - Phone:910-565-2322
Practice Address - Fax:910-479-1401
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVING WELL BEHAVIORAL HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950272Medicaid
NC2335815Medicare UPIN