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General NPI Number Information
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NPI Number | 1245579754
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Entity Type | Individual
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Provider Name | MS. CHANTA LAKEISH LOVE
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Gender | Female
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 4144 LINDELL BLVD SUITE 408
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2927
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Country | US
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Telephone | 314-534-4345
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Fax |
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Provider Business Mailing Address
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Address Line | 9432 W MAIN ST
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City | BELLEVILLE
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State | IL
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Zip | 62223-1713
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Country | US
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Telephone | 618-447-0219
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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