Organization
AUTHENTIC LIVING LAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DELSONDRA JONELL ALLEN LISW- CP (CEO)
(803) 714-3774
Entity
Organization
Contact information
Practice address
220 OLDE SPRINGS RD, COLUMBIA, SC 29223-1612
(803) 714-3774
Mailing address
9600 TWO NOTCH RD, SUITE 5 # 1285, COLUMBIA, SC 29223-1612
(803) 714-3774
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
09/30/2025
Last updated
09/30/2025
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