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General NPI Number Information
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NPI Number | 1437531043
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Entity Type | Organization
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Legal Business Name | LIVING ANEW WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 1830 OWEN DR SUITE 10
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-1611
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Country | US
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Telephone | 910-745-8712
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Fax | 910-705-8447
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Provider Business Mailing Address
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Address Line | PO BOX 42242
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City | FAYETTEVILLE
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State | NC
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Zip | 28309-2242
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Country | US
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Telephone | 910-578-0232
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Fax | 910-705-8447
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MRS. DAWN STATEN DRAKEFORD
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Credential | LPC, LCASA, CCDVC
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Telephone | 910-728-5980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11591
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License Number State | NC
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