Active NPI
Mark C Livak, LCMHCA
- Mental Health Counselor
- Charlotte, NC
National Provider Identifier
1891456802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A17157
- Practice address
- 7751 Ballantyne Commons Pkwy Ste 102
Charlotte, NC 28277-2442 - Phone
- (704) 626-6550
- NPI assigned
- Jan 3, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | A17157 | NC | Primary |
Addresses
Primary practice location
7751 Ballantyne Commons Pkwy Ste 102
Charlotte, NC 28277-2442
Mailing address
3140 Turf CT
Gastonia, NC 28056-6600
Phone (803) 372-8997
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A17157 | NC | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| One:12 Counseling PLLC | Mental Health | Current | Accepting new patients |
Locations
7751 Ballantyne Commons Pkwy
#102
Charlotte, NC 28277
Phone (704) 626-6550
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641168000000",
"number": "1891456802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3140 TURF CT",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280566600",
"telephone_number": "803-372-8997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7751 BALLANTYNE COMMONS PKWY STE 102",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282772442",
"telephone_number": "704-626-6550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIVAK",
"first_name": "MARK",
"middle_name": "C",
"credential": "LCMHCA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-01-03",
"last_updated": "2022-01-03",
"certification_date": "2021-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "A17157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.