MEDICARE: LIVING FORWARD PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1568216737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING FORWARD PLLC

Provider Business Mailing Address
First Line	:	PO BOX 356
Second Line	:
City	:	NEW HILL
State	:	NC
Zip	:	27562-0356
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GLENWOOD AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-2578
Country	:	US
Telephone Number	:	919-348-2473
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LASSANDRA PURNELL
Credential	:	LCSW, ACSW
Telephone Number	:	919-348-2473

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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