Provider Demographics
NPI:1871245498
Name:LOVE OF LYFE LLC
Entity Type:Organization
Organization Name:LOVE OF LYFE LLC
Other - Org Name:
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 1:1509 LAKE CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-7212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4665 HAYGOOD RD STE 401
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5443
Practice Address - Country:US
Practice Address - Phone:757-524-4383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty