MEDICARE: VIDA COLLECTIVE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1629811310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA COLLECTIVE, LLC

Provider Business Mailing Address
First Line	:	420 E 21ST ST STE G
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-2350
Country	:	US
Telephone Number	:	501-300-7456
Fax Number	:	501-600-4811

Provider Business Practice Location Address
First Line	:	420 E 21ST ST STE G
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-2350
Country	:	US
Telephone Number	:	501-300-7456
Fax Number	:	501-600-4811

Authorized Official
Title or Position	:	OWNER
Name	:	ANA R ELDRIDGE
Credential	:	LPC
Telephone Number	:	501-300-7456

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	03/13/2026

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Directions to “VIDA COLLECTIVE, LLC ” Practice Location

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