# AUTHENTIC LIVING LAB LLC

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

## Provider details

- **NPI number:** 1619841038
- **Authorized official:** MISS DELSONDRA JONELL ALLEN LISW- CP (CEO)
- **Authorized official phone:** (803) 714-3774

## Contact information

- **Practice address:** 220 OLDE SPRINGS RD, COLUMBIA, SC 29223-1612
- **Practice address phone:** (803) 714-3774
- **Mailing address:** 9600 TWO NOTCH RD, SUITE 5 \# 1285, COLUMBIA, SC 29223-1612
- **Mailing address phone:** (803) 714-3774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 09/30/2025
- **Last updated:** 09/30/2025