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General NPI Number Information
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NPI Number | 1528571841
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Entity Type | Organization
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Legal Business Name | LIVEWELL GROUP
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 7781 COOPER RD, 2ND FLOOR SUITE 5
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City | CINCINNATI
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State | OH
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Zip | 45242-7728
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Country | US
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Telephone | 513-306-3230
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 613
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City | CHANNAHON
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State | IL
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Zip | 60410-0613
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Country | US
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Telephone | 815-521-1889
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DWONNA THOMPSON
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Credential | PSY.D.
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Telephone | 513-306-3230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | IL
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