Healthcare Provider Details

I. General information

NPI: 1093621534
Provider Name (Legal Business Name): LIV ALIGNED THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 HAVEN RIDGE DR APT 2
WINSTON SALEM NC
27104-5412
US

IV. Provider business mailing address

520 HAVEN RIDGE DR APT 2
WINSTON SALEM NC
27104-5412
US

V. Phone/Fax

Practice location:
  • Phone: 308-940-1512
  • Fax:
Mailing address:
  • Phone: 308-940-1512
  • Fax: 803-907-5391

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: OLIVIA G O'CLAIR
Title or Position: OWNER
Credential: LCMHCA
Phone: 308-940-1512