Provider Demographics
NPI:1811483761
Name:LIVE.BALANCED.LIFE.LLC
Entity type:Organization
Organization Name:LIVE.BALANCED.LIFE.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-705-3086
Mailing Address - Street 1:5305 VILLAGE CENTER DR STE 176
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2382
Mailing Address - Country:US
Mailing Address - Phone:240-705-3086
Mailing Address - Fax:
Practice Address - Street 1:6339 TEN OAKS RD STE 300
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1155
Practice Address - Country:US
Practice Address - Phone:443-904-1817
Practice Address - Fax:410-639-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-03
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6864101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD989010600Medicaid