| Living Life Supportive Services Llc | |
|
20 E Tabb St Ste 205 Petersburg VA 23803-4560 | |
| (804) 536-5066 | |
| (202) 545-3413 |
| Full Name | Living Life Supportive Services Llc |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 20 E Tabb St Ste 205, Petersburg, Virginia |
| Authorized Official Name and Position | Cassandra Merrick (OWNER) |
| Authorized Official Contact | 8045365066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Life Supportive Services Llc 20 E Tabb St Ste 205 Petersburg VA 23803-4560 Ph: (804) 536-5066 | Living Life Supportive Services Llc 20 E Tabb St Ste 205 Petersburg VA 23803-4560 Ph: (804) 536-5066 |
| NPI Number | 1134958820 |
|---|---|
| Provider Enumeration Date | 07/30/2024 |
| Last Update Date | 07/30/2024 |
| Certification Date | 07/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134958820 | NPI | - | NPPES |
| 1912646142 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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