| Entity Name: | LARISSA HUMISTON, LCSW INCORPORATED |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 02 May 2016 (9 years ago) |
| Document Number: | P16000039196 |
| FEI/EIN Number | 56-2672338 |
| Address: | 1414 GAY RD, 205, WINTER PARK, FL 32789 |
| Mail Address: | 1414 GAY RD, 205, WINTER PARK, FL 32789 |
| ZIP code: | 32789 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962976647 | 2019-01-16 | 2019-06-11 | 1414 GAY RD STE 205, WINTER PARK, FL, 327892928, US | 1414 GAY RD STE 205, WINTER PARK, FL, 327892928, US | |||||||||||||||||
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| Phone | +1 407-415-1175 |
Authorized person
| Name | LARISSA K HUMISTON |
| Role | OWNER |
| Phone | 4074151175 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INSURANCE PANELS |
| Number | 1538478714 |
| Name | Role | Address |
|---|---|---|
| HUMISTON, LARISSA K | Agent | 1414 GAY RD, 205, WINTER PARK, FL 32789 |
| Name | Role | Address |
|---|---|---|
| HUMISTON, LARISSA K | President | 1414 GAY RD, 205 WINTER PARK, FL 32789 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000127181 | THERAPY UNCENSORED | ACTIVE | 2022-10-11 | 2027-12-31 | No data | 1414 GAY RD, SUITE 205, WINTER PARK, FL, 32789 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-09 | 1414 GAY RD, 205, WINTER PARK, FL 32789 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-27 |
| ANNUAL REPORT | 2024-03-12 |
| ANNUAL REPORT | 2023-01-10 |
| ANNUAL REPORT | 2022-01-11 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-02-20 |
| ANNUAL REPORT | 2017-01-09 |
| Domestic Profit | 2016-05-02 |
Date of last update: 19 Feb 2025
Sources: Florida Department of State
