Basic Information
| Provider Information | |||||||||
| NPI: | 1386052298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOVE | ||||||||
| FirstName: | KANISHA | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 167 MUSTANG DR | ||||||||
| Address2: | |||||||||
| City: | RED SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283779101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107854701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 CABARRUS AVE E | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280253699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888497379 | ||||||||
| FaxNumber: | 8558577333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2014 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C010280 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.