Provider Demographics
NPI:1679540223
Name:LOVE, NASH W III (LPA)
Entity type:Individual
Prefix:MR
First Name:NASH
Middle Name:W
Last Name:LOVE
Suffix:III
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9723
Mailing Address - Country:US
Mailing Address - Phone:336-246-4542
Mailing Address - Fax:828-262-5687
Practice Address - Street 1:221 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9723
Practice Address - Country:US
Practice Address - Phone:336-246-4542
Practice Address - Fax:828-262-5687
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1354103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCN/AOtherCBHA
NC6107298Medicaid
NC135VROtherBCBS OF NC