Provider Demographics
NPI:1558826362
Name:LLP EARLY INTERVENTION
Entity Type:Organization
Organization Name:LLP EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EARLY INTERVENTION SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRIAN
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-858-8163
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:MC COLL
Mailing Address - State:SC
Mailing Address - Zip Code:29570-0032
Mailing Address - Country:US
Mailing Address - Phone:843-858-8163
Mailing Address - Fax:
Practice Address - Street 1:2048 E HOME AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-7668
Practice Address - Country:US
Practice Address - Phone:843-858-8163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty