Healthcare Provider Details

I. General information

NPI: 1649004680
Provider Name (Legal Business Name): LOVE LAWCD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 GLENWOOD AVE
BALTIMORE MD
21212-4230
US

IV. Provider business mailing address

4904 YORK RD UNIT 4506 #4506
BALTIMORE MD
21212-7501
US

V. Phone/Fax

Practice location:
  • Phone: 240-565-0569
  • Fax:
Mailing address:
  • Phone: 240-565-0569
  • Fax: 240-427-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DE'TRECE ATALIE LAVENDER
Title or Position: OWNER/CLINICIAN
Credential: LCPC
Phone: 240-565-0569