Provider Demographics
NPI:1154514354
Name:LIVING LIFE, LLC
Entity type:Organization
Organization Name:LIVING LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUVALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:352-253-1100
Mailing Address - Street 1:2762 DORA AVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4970
Mailing Address - Country:US
Mailing Address - Phone:352-253-1100
Mailing Address - Fax:352-253-6241
Practice Address - Street 1:2762 DORA AVENUE
Practice Address - Street 2:SUITE 2762
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4970
Practice Address - Country:US
Practice Address - Phone:352-253-1100
Practice Address - Fax:352-253-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH5873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty