Healthcare Provider Details

I. General information

NPI: 1417391053
Provider Name (Legal Business Name): LIVE WELLNESS CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 DUBLIN RD STE 212C
COLUMBUS OH
43215-7037
US

IV. Provider business mailing address

1335 DUBLIN RD STE 212C
COLUMBUS OH
43215-1000
US

V. Phone/Fax

Practice location:
  • Phone: 614-437-9910
  • Fax: 614-453-5975
Mailing address:
  • Phone: 614-437-9910
  • Fax: 614-453-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS1300177
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE1000414
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0500525
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0800038
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0900170
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0004105
License Number StateOH
# 7
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI. 1200483
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI. 0800196 S
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0700075
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS1430005
License Number StateOH
# 11
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 12
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM1300008
License Number StateOH
# 13
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM1300023
License Number StateOH

VIII. Authorized Official

Name: MRS. CHARITY RITTER
Title or Position: DIRECTOR/THERAPIST
Credential: LISW
Phone: 614-437-9910