Provider Demographics
NPI:1336552314
Name:LIVINGWELL COUNSELING AND COACHING
Entity Type:Organization
Organization Name:LIVINGWELL COUNSELING AND COACHING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR ASS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:O
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCA
Authorized Official - Phone:704-947-0954
Mailing Address - Street 1:9816 SAM FURR RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4946
Mailing Address - Country:US
Mailing Address - Phone:704-604-9249
Mailing Address - Fax:
Practice Address - Street 1:9816 SAM FURR RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4946
Practice Address - Country:US
Practice Address - Phone:704-604-9249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9672251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health