Healthcare Provider Details

I. General information

NPI: 1538758792
Provider Name (Legal Business Name): LIVE WELL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22052 GREENTREE LN
NOVI MI
48375-5125
US

IV. Provider business mailing address

22052 GREENTREE LN
NOVI MI
48375-5125
US

V. Phone/Fax

Practice location:
  • Phone: 248-660-6639
  • Fax:
Mailing address:
  • Phone: 248-660-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
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: ANNA MACMILLAN
Title or Position: OWNER
Credential:
Phone: 248-660-6639