Healthcare Provider Details

I. General information

NPI: 1679540223
Provider Name (Legal Business Name): NASH W LOVE III LPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W MAIN ST
JEFFERSON NC
28640-9723
US

IV. Provider business mailing address

221 W MAIN ST
JEFFERSON NC
28640-9723
US

V. Phone/Fax

Practice location:
  • Phone: 336-246-4542
  • Fax: 828-262-5687
Mailing address:
  • Phone: 336-246-4542
  • Fax: 828-262-5687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1354
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: