Healthcare Provider Details

I. General information

NPI: 1831572304
Provider Name (Legal Business Name): SUPPORTING ARMS CONTINUING CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E CONSTANCE RD SUITE B
SUFFOLK VA
23434-3004
US

IV. Provider business mailing address

540 E CONSTANCE RD SUITE B
SUFFOLK VA
23434-3004
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-0407
  • Fax: 757-539-8394
Mailing address:
  • Phone: 757-539-0407
  • Fax: 757-539-8394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number2242
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number0710102165
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number0710102165
License Number StateVA

VIII. Authorized Official

Name: DR. SONYA LEVETTE LEE
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential: ED.D, CSAS
Phone: 757-572-1517