Healthcare Provider Details

I. General information

NPI: 1366878472
Provider Name (Legal Business Name): ONE LOVE PERIODIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 2ND AVE
GASTONIA NC
28052-4095
US

IV. Provider business mailing address

201 W 2ND AVE
GASTONIA NC
28052-4095
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-5254
  • Fax: 704-867-5276
Mailing address:
  • Phone: 704-867-5254
  • Fax: 704-867-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TROY L VEALE
Title or Position: CEO
Credential:
Phone: 704-537-9551