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General NPI Number Information
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NPI Number | 1144181561
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Entity Type | Organization
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Legal Business Name | LIVE.BALANCED.LIFE.LLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 6339 TEN OAKS RD STE 300
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1155
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Country | US
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Telephone | 443-904-1817
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Fax | 410-639-5246
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Provider Business Mailing Address
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Address Line | 6339 TEN OAKS RD STE 300
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1155
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Country | US
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Telephone | 443-904-1817
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Fax | 410-639-5246
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINE N WILLIAMS
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Credential | LCPC
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Telephone | 443-904-1817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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