MEDICARE: LIVING AND GROWING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1083181275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING AND GROWING, LLC

Provider Business Mailing Address
First Line	:	708 GIST AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-5234
Country	:	US
Telephone Number	:	202-412-3666
Fax Number	:	301-565-9621

Provider Business Practice Location Address
First Line	:	8777 1ST AVE # A
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3511
Country	:	US
Telephone Number	:	301-920-0316
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. TERESA D COMBS
Credential	:	PHD, APRN, BC
Telephone Number	:	202-412-3666

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	10/26/2018

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