=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518296524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3S LOVE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2009
-----------------------------------------------------
Last Update Date | 12/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3120 FLORAL GROVE LN APT 101
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28216-6651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-556-2274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3120 FLORAL GROVE LN APT 101
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28216-6651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-556-2274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | SSHARIKA MCFADDEN
-----------------------------------------------------
Credential | MA NCLPC BOARD ELIG
-----------------------------------------------------
Telephone | 803-556-2274
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------