Healthcare Provider Details

I. General information

NPI: 1124954631
Provider Name (Legal Business Name): HEALING HEARTS IDD SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MCKIMMEY RD
CAMDEN NC
27921-6994
US

IV. Provider business mailing address

423 LIFE TREE TRL APT 303
CHESAPEAKE VA
23323-6612
US

V. Phone/Fax

Practice location:
  • Phone: 757-717-2890
  • Fax:
Mailing address:
  • Phone: 757-717-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA WIGGINS MARTIN
Title or Position: OWNER
Credential:
Phone: 757-717-2890