Healthcare Provider Details

I. General information

NPI: 1306794771
Provider Name (Legal Business Name): THE BALANCED BRAIN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 JONES WHITE RD
ROPER NC
27970-9665
US

IV. Provider business mailing address

781 JONES WHITE RD
ROPER NC
27970-9665
US

V. Phone/Fax

Practice location:
  • Phone: 252-505-1963
  • Fax:
Mailing address:
  • Phone: 252-505-1963
  • Fax:

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: KEYOSHIA C LIVERMAN
Title or Position: COUNSELOR/OWNER
Credential: LCMHC-A
Phone: 252-505-1963