Provider Demographics
NPI:1982212536
Name:LIVING WELL INTEGRATIVE COUNSELING, LLC
Entity Type:Organization
Organization Name:LIVING WELL INTEGRATIVE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-680-9558
Mailing Address - Street 1:245 N HIGHLAND AVE NE STE 230-285
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1936
Mailing Address - Country:US
Mailing Address - Phone:678-680-9558
Mailing Address - Fax:
Practice Address - Street 1:245 N HIGHLAND AVE NE STE 230-285
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1936
Practice Address - Country:US
Practice Address - Phone:678-680-9558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health