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General NPI Number Information
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NPI Number | 1669858452
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Entity Type | Organization
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Legal Business Name | DARELIVETHRIVE, PC
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 10436 SANTA MONICA BLVD SUITE 3005 OFFICE #3
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City | LOS ANGELES
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State | CA
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Zip | 90025-6933
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Country | US
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Telephone | 818-370-6423
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Fax | 310-598-7157
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Provider Business Mailing Address
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Address Line | 1203 N SWEETZER AVE # 203
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-3045
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Country | US
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Telephone | 818-370-6423
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Fax | 310-598-7157
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SHANE KENNINGTON
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Credential | LCSW
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Telephone | 818-370-6423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25220
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License Number State | CA
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