Provider Demographics
NPI:1447540158
Name:DISCOVERING AUTHENTIC LIVING, LLC
Entity type:Organization
Organization Name:DISCOVERING AUTHENTIC LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/MEMBER-MANAGED LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCAS
Authorized Official - Phone:704-814-9850
Mailing Address - Street 1:6317 S BEND LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4659
Mailing Address - Country:US
Mailing Address - Phone:704-814-9850
Mailing Address - Fax:704-523-6050
Practice Address - Street 1:6317 S BEND LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4659
Practice Address - Country:US
Practice Address - Phone:704-814-9850
Practice Address - Fax:704-523-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12169428OtherCAQH
NCPTAN 2853487OtherMEDICARE PROVIDER
NC6003191Medicaid