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Organization

LIVING IN FULL EXCELLENCE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS LATASHA MICHELLE BETHEA (CHIEF EXECUTIVE OFFICER/OWNER)
(910) 229-4387
Entity
Organization

Contact information

Practice address
232 MARKET ST, JACKSON, MS 39232-3339
(910) 229-4387
Mailing address
1220 NORTH ST, FAYETTEVILLE, NC 28301-4413
(910) 853-2184

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Enumeration date
09/07/2015
Last updated
03/22/2016
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