Healthcare Provider Details

I. General information

NPI: 1801757232
Provider Name (Legal Business Name): LIVE.BALANCED.LIFE.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6339 TEN OAKS RD STE 300
CLARKSVILLE MD
21029-1155
US

IV. Provider business mailing address

6339 TEN OAKS RD STE 300
CLARKSVILLE MD
21029-1155
US

V. Phone/Fax

Practice location:
  • Phone: 443-904-1817
  • Fax: 410-639-5246
Mailing address:
  • Phone: 443-904-1817
  • Fax: 410-639-5246

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: CHRISTINE N WILLIAMS
Title or Position: CEO
Credential: LCPC
Phone: 443-904-1817