Healthcare Provider Details

I. General information

NPI: 1629495106
Provider Name (Legal Business Name): LIVEWELL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 OLD HOMESTEAD HWY SUITE I
SWANZEY NH
03446-2140
US

IV. Provider business mailing address

217 OLD HOMESTEAD HWY SUITE I
SWANZEY NH
03446-2140
US

V. Phone/Fax

Practice location:
  • Phone: 603-209-6137
  • Fax: 603-499-4455
Mailing address:
  • Phone: 603-209-6137
  • Fax: 603-499-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1001
License Number StateNH

VIII. Authorized Official

Name: MRS. JAMIE ELLEN POULIOT
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: LCMHC
Phone: 603-209-6137