Healthcare Provider Details

I. General information

NPI: 1346648193
Provider Name (Legal Business Name): LATRICE LASHAE LOVE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 FORUM DR # 108
COLUMBIA SC
29229-7942
US

IV. Provider business mailing address

732 DIAL CREEK RD
ELGIN SC
29045-2003
US

V. Phone/Fax

Practice location:
  • Phone: 803-251-9465
  • Fax: 866-736-0574
Mailing address:
  • Phone: 803-331-7767
  • Fax: 866-736-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11317
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6051
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5754
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0015984
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010289
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number009331
License Number StateGA
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6051
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: