Living Life Supportive Services LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

LIVING LIFE SUPPORTIVE SERVICES LLC

Practice address

20 E Tabb St Ste 205
Petersburg, VA 23803-4560

Phone

(804) 536-5066

Fax

(202) 545-3413

NPI assigned

Jul 30, 2024

Last updated

Jul 30, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cassandra Merrick, LPCNPI 1912646142

Title

Owner

Phone

(804) 536-5066

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cassandra Merrick, LPC

  • Professional Counselor
  • Petersburg, VA
  • NPI 1912646142
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1134958820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 E TABB ST STE 205",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034560",
            "telephone_number": "804-536-5066",
            "fax_number": "202-545-3413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 E TABB ST STE 205",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238034560",
            "telephone_number": "804-536-5066",
            "fax_number": "202-545-3413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVING LIFE SUPPORTIVE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-30",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "MERRICK",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-536-5066",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1912646142",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ingrid Lockley
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• Karen L. Louis, RN
• Lisberth N/a Louis
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• Substance Use Disorder Rehabilitation Clinic/Center in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.