Provider Demographics
NPI:1871245498
Name:LOVE OF LYFE LLC
Entity type:Organization
Organization Name:LOVE OF LYFE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SHARAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-202-2321
Mailing Address - Street 1:5295 GREENWICH RD STE 105
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6046
Mailing Address - Country:US
Mailing Address - Phone:757-840-6787
Mailing Address - Fax:757-840-6788
Practice Address - Street 1:5295 GREENWICH RD STE 105
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6046
Practice Address - Country:US
Practice Address - Phone:757-840-6787
Practice Address - Fax:757-840-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty