Life Integrative Medicine

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

LIFE INTEGRATIVE MEDICINE

Practice address

2018 Eastwood Rd
Wilmington, NC 28403-7228

Phone

(910) 787-1358

Fax

(910) 344-0379

NPI assigned

Nov 26, 2019

Organization subpart

No

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

Authorized official

Name

Jeremy Revell, MD

Title

Owner/Provider

Phone

(323) 216-0993

Specialties & licenses 8

Addresses

Locations

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

{
    "created_epoch": "1574726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574726400000",
    "number": "1326684259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2018 EASTWOOD RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284037228",
            "telephone_number": "910-787-1358",
            "fax_number": "910-344-0379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2018 EASTWOOD RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284037228",
            "telephone_number": "910-787-1358",
            "fax_number": "910-344-0379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE INTEGRATIVE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-26",
        "last_updated": "2019-11-26",
        "status": "A",
        "authorized_official_last_name": "REVELL",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "323-216-0993",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurodevelopmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liberty Healthcare Group, LLC
• Liberty Medical Specialties Inc
• Liberty Medical Specialties, Inc
• Liberty Nursing Services, LLC
• Stephen J Liederbach, M.D.
• Life Skills Therapy Center LLC
• Life Transitions Inc.
• Life Transitions Inc.
• Life Worth Living Service
• Life, Inc.

• Psychiatry Physician in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.