NPIMap

Organization Active NPI

Living Well Centre

  • Mental Health Counselor
  • Durham, NC
National Provider Identifier
1104040294
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1653 Issued in NC
Legal business name
LIVING WELL CENTRE
Practice address
1804 MLK Jr Pkwy
Suite 210
Durham, NC 27707-3587
Phone
(919) 489-2254
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Delice Coffey
Title
Ceo
Phone
(919) 489-2254

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 1653 NC Primary

Addresses

Primary practice location

1804 MLK Jr Pkwy
Suite 210
Durham, NC 27707-3587

Mailing address

1804 MLK Jr Pkwy
Suite 210
Durham, NC 27707-3587
Phone (919) 489-2254

Other identifiers 1

IdentifierTypeStateIssuer
5905848MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Living Well Centre4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1104040294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 MLK JR PKWY",
            "address_2": "SUITE 210",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277073587",
            "telephone_number": "919-489-2254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 MLK JR PKWY",
            "address_2": "SUITE 210",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277073587",
            "telephone_number": "919-489-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL CENTRE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "COFFEY",
        "authorized_official_first_name": "DELICE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-489-2254",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "1653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5905848",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.