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General NPI Number Information
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NPI Number | 1528513835
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Entity Type | Organization
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Legal Business Name | THE HEALTHY LIVING CENTER FOUNDATION C/O PRIMARY CARE SPECIALISTS, INC
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Dates
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Enumeration Date | 08/17/2016
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Last Update Date | 10/20/2017
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Provider Practice Location Address
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Address Line | 930 MAJESTIC AVENUE SUITE 110
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City | NORFOLK
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State | VA
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Zip | 23504
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Country | US
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Telephone | 757-622-0542
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Fax | 757-627-5809
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Provider Business Mailing Address
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Address Line | 930 MAJESTIC AVENUE SUITE 110
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City | NORFOLK
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State | VA
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Zip | 23504
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Country | US
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Telephone | 757-622-0542
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Fax | 757-627-5809
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. OLIVIA M NEWBY
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Credential | DNP, FNP-BC, CDE
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Telephone | 757-622-0542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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