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General NPI Number Information
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NPI Number | 1053614297
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Entity Type | Organization
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Legal Business Name | LIVING WELL FAMILY SERVICES LLC
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 293 E WATER ST
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City | BELHAVEN
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State | NC
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Zip | 27810-1451
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Country | US
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Telephone | 252-402-6509
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Fax | 252-558-0665
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Provider Business Mailing Address
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Address Line | PO BOX 114
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City | BELHAVEN
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State | NC
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Zip | 27810-0114
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Country | US
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Telephone | 252-402-6509
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Fax | 252-558-0665
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | MRS. KIMBERLY T WILLIAMS
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Credential | MSW
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Telephone | 252-402-6509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | COO6412
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License Number State | NC
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