Basic Information
| Provider Information | |||||||||
| NPI: | 1679540223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOVE | ||||||||
| FirstName: | NASH | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | LPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286409723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362464542 | ||||||||
| FaxNumber: | 8282625687 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286409723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362464542 | ||||||||
| FaxNumber: | 8282625687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 03/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 1354 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
| ID | Type | State | Issuer | Description | N/A | 01 | NC | CBHA | OTHER | 6107298 | 05 | NC | MEDICAID | 135VR | 01 | NC | BCBS OF NC | OTHER |