Organization
DARELIVETHRIVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANE D KENNINGTON MSW (OWNER)
(818) 370-6423
Entity
Organization
Contact information
Practice address
4730 SW MACADAM AVE, SUITE 201-G, PORTLAND, OR 97239-6417
(818) 370-6423
Mailing address
4730 SW MACADAM AVE, SUITE 201-G, PORTLAND, OR 97239-6417
(818) 370-6423
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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