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General NPI Number Information
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NPI Number | 1619349107
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Entity Type | Organization
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Legal Business Name | LIVING WELL BEHAVIORAL HEALTH LAB
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 2350 BENTRIDGE LN STE 301A
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-0590
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Country | US
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Telephone | 910-748-0261
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Fax | 910-758-9358
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Provider Business Mailing Address
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Address Line | 2350 BENTRIDGE LN STE 301A
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-0590
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Country | US
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Telephone | 910-748-0261
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Fax | 910-758-9358
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA DELEURAN
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Credential |
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Telephone | 919-803-2111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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