# LIFE FULLY LIVED, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003408352
- **Authorized official:** MEGAN DOYLE LPCMH (OWNER)
- **Authorized official phone:** (443) 466-7038

## Contact information

- **Practice address:** 19 BRANDYWINE BLVD, TALLEYVILLE, DE 19803-1838
- **Practice address phone:** (302) 703-7779
- **Mailing address:** 19 BRANDYWINE BLVD, TALLEYVILLE, DE 19803-1838
- **Mailing address phone:** (302) 703-7779

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/08/2021
- **Last updated:** 12/24/2023