Living Legacies Therapeutic Services PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

LIVING LEGACIES THERAPEUTIC SERVICES PLLC

Practice address

10130 Mallard Creek Rd Ste 300
Charlotte, NC 28262-6001

Phone

(980) 225-1585

Fax

(980) 701-0046

NPI assigned

Nov 18, 2019

Organization subpart

No

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

Authorized official

Name

Amber Kimble, LCSWNPI 1033599618

Title

Owner

Phone

(980) 225-1585

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amber Kimble, LCSW

  • Clinical Social Worker
  • Charlotte, NC
  • NPI 1033599618
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1574035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574035200000",
    "number": "1699311340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10130 MALLARD CREEK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626001",
            "telephone_number": "980-225-1585",
            "fax_number": "980-701-0046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10130 MALLARD CREEK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626001",
            "telephone_number": "980-225-1585",
            "fax_number": "980-701-0046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING LEGACIES THERAPEUTIC SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-18",
        "last_updated": "2019-11-18",
        "status": "A",
        "authorized_official_last_name": "KIMBLE",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "980-225-1585",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Livewell Inc
• Livewell Medical Inc
• Living at Ease Incorporated
• Living at Ease Incorporated
• Living Expectantly R.D. LLC
• Living Without Barriers LLC
• Bronah Miller Livingston, LPC, NCC
• Kenya Livingston, MA
• Michael Balfour Livingston, MD
• Ryan Edward Livingston, MD

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.