Living Well Collective Co

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

LIVING WELL COLLECTIVE CO

Practice address

12400 Yellow Bluff Rd Ste 107
Jacksonville, FL 32226-5070

Phone

(904) 339-5937

NPI assigned

May 11, 2021

Last updated

Mar 29, 2022By 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

Ms. Carissa L DoreNPI 1982959961

Title

Ceo

Phone

(904) 339-5937

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carissa Lynette Dore, LMHC

  • Mental Health Counselor
  • Jacksonville, FL
  • NPI 1982959961
  NPD Authorized official

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

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648512000000",
    "number": "1700460250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12400 YELLOW BLUFF RD STE 107",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322265070",
            "telephone_number": "904-339-5937",
            "fax_number": "904-615-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12400 YELLOW BLUFF RD STE 107",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322265070",
            "telephone_number": "904-339-5937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING WELL COLLECTIVE CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-11",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "DORE",
        "authorized_official_first_name": "CARISSA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-339-5937",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Live Well M.D.
• Mark A Livecchi, MD
• Tomasina Egette Livermon
• Torshader Liverpool
• Living in Hope Counseling, LLC
• Gaynell L Livingston-Hodges, MEDICAID PROVIDER
• Jamie Brescia Livingston
• Luke William Livingston
• Samuel Francis Livingston II, M.D.
• Tawana Lizzmore

• Mental Health Clinic/Center (Including Community Mental Health Center) in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.