=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023758521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVE WELL COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2022
-----------------------------------------------------
Last Update Date | 03/31/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 867 BURKS HILL RD
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24523-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-944-9963
-----------------------------------------------------
Fax | 540-617-0994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 198 RETREAT LN
-----------------------------------------------------
City | HUDDLESTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24104-3579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-944-9963
-----------------------------------------------------
Fax | 540-617-0994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. DONNA J NEDER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 540-944-9963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------