Healthcare Provider Details

I. General information

NPI: 1093250078
Provider Name (Legal Business Name): GEVETTE LOVE CDCA, COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 W CENTRAL AVE
TOLEDO OH
43606-2945
US

IV. Provider business mailing address

112 SAN RAFAEL AVE
TOLEDO OH
43607-2415
US

V. Phone/Fax

Practice location:
  • Phone: 567-316-7253
  • Fax: 567-316-7232
Mailing address:
  • Phone: 419-407-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number100811
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: