Healthcare Provider Details

I. General information

NPI: 1538876776
Provider Name (Legal Business Name): LIVE WELL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 NEWBURYPORT TPKE # 352
ROWLEY MA
01969-2014
US

IV. Provider business mailing address

174 NEWBURYPORT TPKE # 352
ROWLEY MA
01969-2014
US

V. Phone/Fax

Practice location:
  • Phone: 978-270-2617
  • Fax:
Mailing address:
  • Phone: 978-270-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA COFFEY
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LICSW
Phone: 978-270-2617