Provider Demographics
NPI:1922389691
Name:LIVE WELL LIFE CENTER
Entity Type:Organization
Organization Name:LIVE WELL LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHRISTIAN COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PASTORAL COUNSELOR
Authorized Official - Phone:404-748-2778
Mailing Address - Street 1:1893 DOVONSHIRE RD SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4078
Mailing Address - Country:US
Mailing Address - Phone:404-748-2778
Mailing Address - Fax:
Practice Address - Street 1:1893 DOVONSHIRE RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4078
Practice Address - Country:US
Practice Address - Phone:404-748-2778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care