MEDICARE: ANGEL LOVE CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA174002	OH

General Provider Information

NPI Number	:	1588393003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL LOVE CDCA

Provider Business Mailing Address
First Line	:	92 S WARREN AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-3051
Country	:	US
Telephone Number	:	614-427-8184
Fax Number	:

Provider Business Practice Location Address
First Line	:	2758 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-4407
Country	:	US
Telephone Number	:	614-219-9394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2022
Last Update Date	:	06/09/2022

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Directions to “ ANGEL LOVE CDCA” Practice Location

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