Provider Demographics
NPI:1215755020
Name:LIVING WELL GENETIC COUNSELING LLC
Entity type:Organization
Organization Name:LIVING WELL GENETIC COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:CHASSEVENT
Authorized Official - Suffix:
Authorized Official - Credentials:CGC
Authorized Official - Phone:360-852-0849
Mailing Address - Street 1:427 MOSHER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3447
Mailing Address - Country:US
Mailing Address - Phone:360-852-0849
Mailing Address - Fax:
Practice Address - Street 1:427 MOSHER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3447
Practice Address - Country:US
Practice Address - Phone:360-852-0849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Single Specialty