Organization
LIVE WELL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA ANTWI PMHNP (APRN)
(240) 408-0736
Entity
Organization
Contact information
Practice address
1331 BURNSIDE AVE APT A4, EAST HARTFORD, CT 06108-1577
(240) 408-0736
Mailing address
304 W MAIN ST STE 2, AVON, CT 06001-4355
(240) 408-0736
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/08/2024
Last updated
05/08/2024
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