Provider Demographics
NPI:1447670013
Name:LIVE WELL THERAPY GROUP
Entity type:Organization
Organization Name:LIVE WELL THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMITRJEVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-303-9892
Mailing Address - Street 1:260 PALERMO AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6606
Mailing Address - Country:US
Mailing Address - Phone:786-303-9892
Mailing Address - Fax:
Practice Address - Street 1:260 PALERMO AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6606
Practice Address - Country:US
Practice Address - Phone:786-303-9892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty