Healthcare Provider Details

I. General information

NPI: 1467075432
Provider Name (Legal Business Name): LIVING BEYOND IT COUNSELING AND CONSULTATION SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2020
Last Update Date: 05/25/2020
Certification Date: 05/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BRIGHTLEAF BLVD STE 6
SMITHFIELD NC
27577-4077
US

IV. Provider business mailing address

212 BROOKSIDE DR
SMITHFIELD NC
27577-3054
US

V. Phone/Fax

Practice location:
  • Phone: 919-631-4831
  • Fax: 919-400-4602
Mailing address:
  • Phone: 919-631-4831
  • Fax: 919-400-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. RENEE WATSON ADAMS
Title or Position: OWNER
Credential: MS, LCMHC, LCAS, CCS
Phone: 919-631-4831