Organization
LIVING LIFE SUPPORTIVE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSANDRA MERRICK LPC (OWNER)
(804) 536-5066
Entity
Organization
Contact information
Practice address
20 E TABB ST STE 205, PETERSBURG, VA 23803-4560
(804) 536-5066
(202) 545-3413
Mailing address
20 E TABB ST STE 205, PETERSBURG, VA 23803-4560
(804) 536-5066
(202) 545-3413
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912646142
—
VA
Enumeration date
07/30/2024
Last updated
07/30/2024
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