Healthcare Provider Details

I. General information

NPI: 1407472012
Provider Name (Legal Business Name): VIRGINIA'S LOVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 03/02/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9766 GOVERNOR HARRISON PKWY SUITE D
LAWRENCEVILLE VA
23868
US

IV. Provider business mailing address

13300 BELSPRING CT
CHESTER VA
23831-4613
US

V. Phone/Fax

Practice location:
  • Phone: 434-865-4268
  • Fax:
Mailing address:
  • Phone: 434-865-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARITY THOMPSON
Title or Position: OWNER
Credential: LPC, LSATP
Phone: 434-865-4268