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Organization
LIVING WELL 4 LIFE
Active
Organization
LIVING WELL 4 LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REKISHIA L MCMILLAN MSW (OWNER)
(732) 966-5809
Entity
Organization
Contact information
Practice address
405 DAFFODIL DR, JACKSON, NJ 08527-4125
(732) 966-5809
Mailing address
405 DAFFODIL DR, JACKSON, NJ 08527-4125
(732) 966-5809
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14356384
CAQH
NJ
Enumeration date
07/06/2020
Last updated
07/06/2020
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