MEDICARE: LIVING WELL CENTRE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710078761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WELL CENTRE, INC.

Provider Business Mailing Address
First Line	:	1804 MARTIN LUTHER KING PKWY
Second Line	:	SUITE 210
City	:	DURHAM
State	:	NC
Zip	:	27707-3587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 MARTIN LUTHER KING PKWY
Second Line	:	SUITE 210
City	:	DURHAM
State	:	NC
Zip	:	27707-3587
Country	:	US
Telephone Number	:	919-489-2254
Fax Number	:	919-403-1551

Authorized Official
Title or Position	:	CEO
Name	:	MISS DELICE COFFEY
Credential	:
Telephone Number	:	919-489-2254

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	04/24/2009

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