Healthcare Provider Details

I. General information

NPI: 1700237039
Provider Name (Legal Business Name): LIVE AND LEARN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 BELLS FERRY DR
BILOXI MS
39531-2258
US

IV. Provider business mailing address

989 GREYSTONE DR
BILOXI MS
39532-2251
US

V. Phone/Fax

Practice location:
  • Phone: 601-384-7551
  • Fax:
Mailing address:
  • Phone: 601-384-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2191
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2191
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number2191
License Number StateMS

VIII. Authorized Official

Name: MRS. CAMILLA JOY MOORE
Title or Position: THERAPIST,PSYCHOMETRIST,
Credential: LPC, NCC
Phone: 601-384-7551