Healthcare Provider Details

I. General information

NPI: 1710275409
Provider Name (Legal Business Name): ONE LOVE PERIODIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N GREEN ST
MORGANTON NC
28655-3466
US

IV. Provider business mailing address

103 NORTH GREEN STREET
MORGANTON NC
28655-3483
US

V. Phone/Fax

Practice location:
  • Phone: 828-433-4567
  • Fax: 828-433-4576
Mailing address:
  • Phone: 828-433-4567
  • Fax: 828-433-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberMHL-012-095
License Number StateNC

VIII. Authorized Official

Name: STEVIE LYNN WIDEMAN
Title or Position: CEO
Credential:
Phone: 828-433-4567