| Love Lawcd Llc | |
|
4359 Northview Dr Bowie MD 20716-2603 | |
| (240) 565-0569 | |
| Not Available |
| Full Name | Love Lawcd Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4359 Northview Dr, Bowie, Maryland |
| Authorized Official Name and Position | Detrece Lavender (OWNER) |
| Authorized Official Contact | 2405650569 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Love Lawcd Llc 4904 York Rd Unit 4506 Baltimore MD 21212-7501 Ph: () - | Love Lawcd Llc 4359 Northview Dr Bowie MD 20716-2603 Ph: (240) 565-0569 |
| NPI Number | 1649004680 |
|---|---|
| Provider Enumeration Date | 08/30/2024 |
| Last Update Date | 08/30/2024 |
| Certification Date | 08/30/2024 |
| Medicare PECOS PAC ID | 3072054170 |
|---|---|
| Medicare Enrollment ID | O20240917000801 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649004680 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | De'trece Atalie Lavender |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073274387 PECOS PAC ID: 8921549148 Enrollment ID: I20240916000954 |
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