Provider Demographics
NPI:1477331213
Name:EXPERT OF LIVED EXPERIENCE LLC
Entity Type:Organization
Organization Name:EXPERT OF LIVED EXPERIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION EXECUTIVE CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERNELL
Authorized Official - Middle Name:TAMIKA
Authorized Official - Last Name:MACKIE
Authorized Official - Suffix:
Authorized Official - Credentials:CART,CPLC,CDVS,CCTS
Authorized Official - Phone:704-817-8814
Mailing Address - Street 1:8539 MONROE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-7510
Mailing Address - Country:US
Mailing Address - Phone:704-817-8814
Mailing Address - Fax:888-706-9896
Practice Address - Street 1:8539 MONROE RD # 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-7510
Practice Address - Country:US
Practice Address - Phone:704-817-8814
Practice Address - Fax:888-706-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty