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General NPI Number Information
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NPI Number | 1982212536
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Entity Type | Organization
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Legal Business Name | LIVING WELL INTEGRATIVE COUNSELING, LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 245 N HIGHLAND AVE NE STE 230-285
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City | ATLANTA
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State | GA
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Zip | 30307-1936
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Country | US
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Telephone | 678-680-9558
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Fax |
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Provider Business Mailing Address
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Address Line | 245 N HIGHLAND AVE NE STE 230-285
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City | ATLANTA
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State | GA
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Zip | 30307-1936
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Country | US
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Telephone | 678-680-9558
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | JUANITA DAVIS
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Credential | LCSW
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Telephone | 678-680-9558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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