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General NPI Number Information
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NPI Number | 1376392464
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Entity Type | Organization
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Legal Business Name | LIVE BODY BRAVE
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Dates
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Enumeration Date | 05/13/2024
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 1611 COLLEY AVE STE A
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City | NORFOLK
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State | VA
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Zip | 23517-1677
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Country | US
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Telephone | 757-201-0509
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Fax |
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Provider Business Mailing Address
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Address Line | 420 W 36TH ST
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City | NORFOLK
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State | VA
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Zip | 23508-3206
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Country | US
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Telephone | 757-681-6676
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RACHEL MICHELETTI
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Credential | LPC
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Telephone | 757-681-6676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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