Healthcare Provider Details

I. General information

NPI: 1306335302
Provider Name (Legal Business Name): LIVE IN LOVE COMMUNITY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 S MILITARY HWY STE B
CHESAPEAKE VA
23320-5987
US

IV. Provider business mailing address

70 KING GEORGE QUAY
CHESAPEAKE VA
23325-4771
US

V. Phone/Fax

Practice location:
  • Phone: 757-917-8147
  • Fax: 757-204-2350
Mailing address:
  • Phone: 757-917-8147
  • Fax: 757-204-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2705
License Number StateVA

VIII. Authorized Official

Name: MISS TERAH THOMAS WALKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 757-917-8147