Healthcare Provider Details

I. General information

NPI: 1871360875
Provider Name (Legal Business Name): LIVING YOUR BEST LIFE HEALTH COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 LADY ST OFC 226
COLUMBIA SC
29201-3489
US

IV. Provider business mailing address

1122 LADY ST OFC 226
COLUMBIA SC
29201-3489
US

V. Phone/Fax

Practice location:
  • Phone: 803-404-0454
  • Fax:
Mailing address:
  • Phone: 803-404-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: MRS. BROOKE AUTUMN BOWMAN
Title or Position: HEALTH COACH
Credential:
Phone: 803-404-0454