| Live Well Healthcare Pllc | |
|
10432 Balls Ford Rd Ste 300 Manassas VA 20109-2517 | |
| (571) 931-2533 | |
| Not Available |
| Full Name | Live Well Healthcare Pllc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 10432 Balls Ford Rd Ste 300, Manassas, Virginia |
| Authorized Official Name and Position | Enyonam Jordan-brangman (NURSE PRACTITIONER) |
| Authorized Official Contact | 5712474434 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Well Healthcare Pllc 10432 Balls Ford Rd Ste 300 Manassas VA 20109-2517 Ph: () - | Live Well Healthcare Pllc 10432 Balls Ford Rd Ste 300 Manassas VA 20109-2517 Ph: (571) 931-2533 |
| NPI Number | 1912612904 |
|---|---|
| Provider Enumeration Date | 01/16/2023 |
| Last Update Date | 01/16/2023 |
| Certification Date | 01/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912612904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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