Provider Demographics
NPI:1396907911
Name:LIVE WELL COUNSELING, PLLC
Entity type:Organization
Organization Name:LIVE WELL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-723-2896
Mailing Address - Street 1:PO BOX 1871
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-1871
Mailing Address - Country:US
Mailing Address - Phone:252-723-2896
Mailing Address - Fax:252-622-4719
Practice Address - Street 1:4125 BONHAM ST
Practice Address - Street 2:A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2840
Practice Address - Country:US
Practice Address - Phone:252-723-2896
Practice Address - Fax:252-622-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0051041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006446Medicaid