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General NPI Number Information
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NPI Number | 1205547064
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Entity Type | Organization
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Legal Business Name | LIVING IN BALANCE
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 545 N AZALEA RD
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City | PETERSBURG
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State | VA
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Zip | 23805-1420
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Country | US
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Telephone | 804-926-4855
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Fax |
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Provider Business Mailing Address
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Address Line | 10418 CENTRALIA STATION RD
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City | CHESTER
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State | VA
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Zip | 23831-1143
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Country | US
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Telephone | 804-926-4855
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TAMARA MISCHA LUCAS
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Credential |
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Telephone | 804-926-4855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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