Healthcare Provider Details

I. General information

NPI: 1699554469
Provider Name (Legal Business Name): CHAQUAN LOVE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 W SAGINAW HWY
LANSING MI
48917-2697
US

IV. Provider business mailing address

4330 KELLER RD APT 52
HOLT MI
48842-1260
US

V. Phone/Fax

Practice location:
  • Phone: 517-541-7619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023077
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: