Provider Demographics
NPI:1669858452
Name:DARELIVETHRIVE, PC
Entity type:Organization
Organization Name:DARELIVETHRIVE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-370-6423
Mailing Address - Street 1:1203 N SWEETZER AVE
Mailing Address - Street 2:# 203
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3045
Mailing Address - Country:US
Mailing Address - Phone:818-370-6423
Mailing Address - Fax:310-598-7157
Practice Address - Street 1:10436 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 3005 OFFICE #3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6933
Practice Address - Country:US
Practice Address - Phone:818-370-6423
Practice Address - Fax:310-598-7157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty