Healthcare Provider Details

I. General information

NPI: 1013762798
Provider Name (Legal Business Name): LIVING AUTHENTICALLY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 BEL AIR BLVD STE 304
MOBILE AL
36606-3507
US

IV. Provider business mailing address

1164 ALBA ST
MOBILE AL
36605-1556
US

V. Phone/Fax

Practice location:
  • Phone: 251-289-1184
  • Fax:
Mailing address:
  • Phone: 251-680-4217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAWANA D KENNEDY
Title or Position: BUSINESS OWNER
Credential: LPC
Phone: 251-289-1184