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General NPI Number Information
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NPI Number | 1417288580
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Entity Type | Organization
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Legal Business Name | LIVING WELL INTERNATIONAL CENTER, PC
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 5710 SIX FORKS RD
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City | RALEIGH
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State | NC
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Zip | 27609-8617
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Country | US
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Telephone | 919-673-4221
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Fax | 919-301-8957
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Provider Business Mailing Address
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Address Line | 5155 PINEHALL WYND
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City | RALEIGH
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State | NC
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Zip | 27604-5825
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Country | US
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Telephone | 919-673-4221
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Fax | 919-301-8957
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. ANGELA ORE GREEN
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Credential | LPC
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Telephone | 919-673-4221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7229
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License Number State | NC
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