# LIVING WATER HEALTH AND WELLNESS LLC

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

## Provider details

- **NPI number:** 1902349335
- **Authorized official:** MS. STEPHANIE THOMAS (CEO)
- **Authorized official phone:** (202) 460-6876

## Contact information

- **Practice address:** 2636 WADE RD SE APT 11, WASHINGTON, DC 20020-5906
- **Practice address phone:** (202) 460-6876
- **Mailing address:** 6300 GRENFELL CT, BOWIE, MD 20720-5331
- **Mailing address phone:** (202) 460-6876

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225500000X | Respiratory/Developmental/Rehabilitative Specialist/Technologist | — | NULL | — |
| 225500000X | Respiratory/Developmental/Rehabilitative Specialist/Technologist | — | — | — |
| 2255A2300X | Athletic Trainer | — | NULL | — |
| 2255A2300X | Athletic Trainer | — | — | — |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/03/2016
- **Last updated:** 01/15/2018