Portia Eboni Carlisle, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

702 S Ridgewood Ave
Daytona Beach, FL 32114-5332

Phone

(800) 800-5394

NPI assigned

Feb 16, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Interoperability endpoints

• Direct secure messaging: portia.carlisle.p1@direct.smahealthcare.nextgenshare.com

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

{
    "created_epoch": "1613433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1568055010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30B LOUVET LN",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321379701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 S RIDGEWOOD AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321145332",
            "telephone_number": "800-800-5394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLISLE",
        "first_name": "PORTIA",
        "middle_name": "EBONI",
        "credential": "LMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-16",
        "last_updated": "2021-02-16",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Salvatore Mark Caridi, D.O.
• Caring for Your Loved Ones, LLC
• Caring Hearts Assisted Living
• Adela D Carino Caidic, MD
• James E Carley, M.D.
• Kathi Carlson
• Carlton Shores Healthcare and Rehabilitation Center LLC
• Carlton Shores NH LLC
• Michelle Lee Caro, APRN FNP-C
• Lawrie Carpenter-Staples

• All providers in Daytona Beach, FL
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.