=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679177497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIVING AT PEACE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2020
-----------------------------------------------------
Last Update Date | 11/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 S 2ND ST
-----------------------------------------------------
City | SAINT PAULS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28384-1507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-496-5450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9170 NC HIGHWAY 20
-----------------------------------------------------
City | LUMBER BRIDGE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28357-8033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-496-5450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/OWNER
-----------------------------------------------------
Name | MS. SHERRY MARIE MATTHEWS
-----------------------------------------------------
Credential | MSW, LCSWA, CCSOTS
-----------------------------------------------------
Telephone | 910-496-5450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------