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General NPI Number Information
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NPI Number | 1396892055
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Entity Type | Individual
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Provider Name | PAMALA TATOYA LOVE PHDC, LCSW, TF-CBT
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 1201 FORESTDALE DR
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City | SALISBURY
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State | NC
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Zip | 28144
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Country | US
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Telephone | 910-541-9114
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Fax | 336-447-6112
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Provider Business Mailing Address
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Address Line | 9526 ARGYLE FOREST BLVD STE B2, #602
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City | JACKSONVILLE
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State | FL
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Zip | 32222
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Country | US
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Telephone | 910-248-9359
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Fax | 980-338-8519
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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 | CSW006295
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C006040
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW21082
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License Number State | FL
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