Provider Demographics
NPI:1770142697
Name:WELL LIVING LLC
Entity type:Organization
Organization Name:WELL LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEDD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:475-367-9114
Mailing Address - Street 1:30 HAZEL TER STE 20
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2240
Mailing Address - Country:US
Mailing Address - Phone:475-367-9114
Mailing Address - Fax:
Practice Address - Street 1:30 HAZEL TER STE 20
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2240
Practice Address - Country:US
Practice Address - Phone:475-441-4339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health