Expert of Lived Experience LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

EXPERT OF LIVED EXPERIENCE LLC

Practice address

8539 Monroe Rd # 105
Charlotte, NC 28212-7510

Phone

(704) 817-8814

Fax

(888) 706-9896

NPI assigned

Sep 21, 2023

Last updated

Feb 15, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Vernell Tamika Mackie, CART,CPLC,CDVS,CCTS

Title

Operation Executive Ceo

Phone

(704) 817-8814

Specialties & licenses 12

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1477331213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8539 MONROE RD STE 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282127510",
            "telephone_number": "704-817-8814",
            "fax_number": "888-706-9896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8539 MONROE RD # 105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282127510",
            "telephone_number": "704-817-8814",
            "fax_number": "888-706-9896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPERT OF LIVED EXPERIENCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-21",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A",
        "authorized_official_last_name": "MACKIE",
        "authorized_official_first_name": "VERNELL",
        "authorized_official_middle_name": "TAMIKA",
        "authorized_official_title_or_position": "OPERATION EXECUTIVE CEO",
        "authorized_official_telephone_number": "704-817-8814",
        "authorized_official_credential": "CART,CPLC,CDVS,CCTS"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "",
            "desc": "Counselor, Pastoral",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "374K00000X",
            "taxonomy_group": "",
            "desc": "Religious Nonmedical Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.