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Organization
LIVING WELL COLLECTIVE CO
Active
Organization
LIVING WELL COLLECTIVE CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARISSA L DORE (CEO)
(904) 339-5937
Entity
Organization
Contact information
Practice address
12400 YELLOW BLUFF RD STE 107, JACKSONVILLE, FL 32226-5070
(904) 339-5937
Mailing address
12400 YELLOW BLUFF RD STE 107, JACKSONVILLE, FL 32226-5070
(904) 339-5937
(904) 615-6978
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/11/2021
Last updated
03/29/2022
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