| Entity Name: | STACY CARMICHAEL PHD LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 16 Sep 2015 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Jan 2017 (8 years ago) |
| Document Number: | L15000157491 |
| FEI/EIN Number | 47-5061458 |
| Address: | 310 South Dillard St., Suite 160, Winter Garden, FL 34787 |
| Mail Address: | 310 South Dillard St, Suite 160, Winter Garden, FL 34787 |
| ZIP code: | 34787 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851965339 | 2021-05-18 | 2021-05-18 | 663 E PLANT ST, WINTER GARDEN, FL, 347873144, US | 310 S DILLARD ST STE 160, WINTER GARDEN, FL, 347873500, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 727-481-2444 |
| Fax | 3212345587 |
| Phone | +1 407-415-1450 |
Authorized person
| Name | DR. STACY LYNN CARMICHAEL |
| Role | OWNER |
| Phone | 4074151450 |
Taxonomy
| Taxonomy Code | 103TC2200X - Clinical Child & Adolescent Psychologist |
| Is Primary | Yes |
| Taxonomy Code | 103TS0200X - School Psychologist |
| Is Primary | No |
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | DR. VISTA NPI |
| Number | 1679122048 |
| Issuer | NPI |
| Number | 1275667750 |
| Issuer | GABY ZERPA LMHC NPI |
| Number | 1063771376 |
| Name | Role | Address |
|---|---|---|
| CARMICHAEL, STACY | Agent | 663 East Plant Street, Winter Garden, FL 34787 |
| Name | Role | Address |
|---|---|---|
| CARMICHAEL, STACY | Authorized Member | 663 East Plant Street, Orlando, FL 34787 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000030280 | MINDWORKS PSYCHOLOGICAL SERVICES | ACTIVE | 2018-03-05 | 2028-12-31 | No data | 310 S. DILLARD ST., SUITE 160, WINTER GARDEN, FL, 34787 |
| G18000024152 | MIND WORKS,PSYCHOLOGICAL AND DIAGNOSTIC SERVICES | EXPIRED | 2018-02-16 | 2023-12-31 | No data | 161 S BOYD ST SUITE 120, WINTER GARDEN, FL, 34787 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-12 | 310 South Dillard St., Suite 160, Winter Garden, FL 34787 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-12 | 310 South Dillard St., Suite 160, Winter Garden, FL 34787 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-06 | 663 East Plant Street, Winter Garden, FL 34787 | No data |
| REINSTATEMENT | 2017-01-30 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-01-30 | CARMICHAEL, STACY | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-03 |
| ANNUAL REPORT | 2023-01-11 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-03-06 |
| ANNUAL REPORT | 2019-01-16 |
| ANNUAL REPORT | 2018-02-12 |
| REINSTATEMENT | 2017-01-30 |
| Florida Limited Liability | 2015-09-16 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
