Healthcare Provider Details

I. General information

NPI: 1952192601
Provider Name (Legal Business Name): THE LOVE IDENTITY FOUNDATION & ENCOURAGEMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 DELTA BLVD STE 101
TALLAHASSEE FL
32303-4874
US

IV. Provider business mailing address

2016 DELTA BLVD STE 101
TALLAHASSEE FL
32303-4874
US

V. Phone/Fax

Practice location:
  • Phone: 850-597-9901
  • Fax:
Mailing address:
  • Phone: 850-597-9901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN WARREN
Title or Position: CEO
Credential:
Phone: 850-226-5262