Healthcare Provider Details

I. General information

NPI: 1376466243
Provider Name (Legal Business Name): LIVING WELL PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 NEW BRIDGE ST STE 3
JACKSONVILLE NC
28540-4737
US

IV. Provider business mailing address

226 NEW BRIDGE ST STE 3
JACKSONVILLE NC
28540-4737
US

V. Phone/Fax

Practice location:
  • Phone: 910-787-1413
  • Fax: 910-222-3027
Mailing address:
  • Phone: 910-787-1413
  • Fax: 910-222-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. MEGAN LIFE COUNSELING THOMPSON
Title or Position: PRACTICE OWNER AND CLINICIAN
Credential: LCSW
Phone: 910-787-1413