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General NPI Number Information
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NPI Number | 1003366261
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Entity Type | Individual
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Provider Name | MR. KENNETH LOVE II
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Gender | Male
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 14799 DIX TOLEDO RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-2507
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Country | US
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Telephone | 734-324-8326
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Fax | 734-324-8327
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Provider Business Mailing Address
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Address Line | 11326 GODDARD CT
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City | TAYLOR
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State | MI
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Zip | 48180-6218
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Country | US
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Telephone | 734-324-8326
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Fax | 734-324-8327
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | MI
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