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General NPI Number Information
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NPI Number | 1114689403
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Entity Type | Organization
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Legal Business Name | LIVEWELL THERAPY, PLLC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 1610-C GLENWOOD AVE
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City | RALEIGH
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State | NC
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Zip | 27608
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Country | US
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Telephone | 984-212-5533
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 GLENWOOD AVE SUITE C
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City | RALEIGH
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State | NC
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Zip | 27608
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | LINDSAY D MCAULAY
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Credential | LCMHC
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Telephone | 984-212-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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