Provider Demographics
NPI:1174711014
Name:CENTER FOR LIVING ENRICHMENT
Entity type:Organization
Organization Name:CENTER FOR LIVING ENRICHMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:828-456-1999
Mailing Address - Street 1:1170 SOUTH MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-2410
Mailing Address - Country:US
Mailing Address - Phone:828-456-1999
Mailing Address - Fax:828-456-2333
Practice Address - Street 1:1170 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-2242
Practice Address - Country:US
Practice Address - Phone:828-456-1999
Practice Address - Fax:828-456-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0047781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2869689Medicare PIN