Healthcare Provider Details

I. General information

NPI: 1275972374
Provider Name (Legal Business Name): ALISHA GALE LOVE LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 JOHNSON RD SW
HUNTSVILLE AL
35805-5847
US

IV. Provider business mailing address

3000 JOHNSON RD SW
HUNTSVILLE AL
35805-5847
US

V. Phone/Fax

Practice location:
  • Phone: 256-650-1729
  • Fax: 256-650-1780
Mailing address:
  • Phone: 256-650-1729
  • Fax: 256-650-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0480G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: