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General NPI Number Information
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NPI Number | 1922829365
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Entity Type | Organization
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Legal Business Name | LIVING WATER MENTAL HEALTH BRAIN TREATMENT CENTER
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 1086 LONDON ST STE B
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5761
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Country | US
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Telephone | 843-839-9688
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Fax |
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Provider Business Mailing Address
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Address Line | 1086 LONDON ST STE B
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5761
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Country | US
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Telephone | 843-938-5913
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Fax | 843-627-4617
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BENJAMIN GREENZWEIG
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Credential |
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Telephone | 843-839-9688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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