# LIVE WELL HEALTHCARE

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

## Provider details

- **NPI number:** 1912612904
- **Authorized official:** ENYONAM JORDAN-BRANGMAN NP (NP)
- **Authorized official phone:** (571) 931-2533

## Contact information

- **Practice address:** 20130 LAKEVIEW CENTER PLZ STE 400, ASHBURN, VA 20147-5905
- **Practice address phone:** (571) 931-2533
- **Practice address fax:** (571) 365-7530
- **Mailing address:** 20130 LAKEVIEW CENTER PLZ STE 400, ASHBURN, VA 20147-5905
- **Mailing address phone:** (571) 931-2533
- **Mailing address fax:** (571) 365-7530

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0850X | Adult Mental Health Clinic/Center | — | — | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/16/2023
- **Last updated:** 10/07/2026