Healthcare Provider Details

I. General information

NPI: 1801753371
Provider Name (Legal Business Name): PREMEDITATED PROSPERITY COUNSELING AND CONSULTING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MCLEAN ST
RAEFORD NC
28376-2350
US

IV. Provider business mailing address

905 MCLEAN ST
RAEFORD NC
28376-2350
US

V. Phone/Fax

Practice location:
  • Phone: 910-309-8053
  • Fax:
Mailing address:
  • Phone: 910-309-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMY LOVE
Title or Position: CLINICIAN/OWNER
Credential: LCSW
Phone: 910-309-8053