Provider Demographics
NPI:1427325372
Name:LIVING WELL CENTERS PRIMARY CARE AND BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:LIVING WELL CENTERS PRIMARY CARE AND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-812-5988
Mailing Address - Street 1:101 RICE BENT WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-6849
Mailing Address - Country:US
Mailing Address - Phone:803-667-9312
Mailing Address - Fax:803-667-9313
Practice Address - Street 1:101 RICE BENT WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-6849
Practice Address - Country:US
Practice Address - Phone:803-667-9312
Practice Address - Fax:803-667-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty