Provider Demographics
NPI:1366878472
Name:ONE LOVE PERIODIC SERVICES
Entity type:Organization
Organization Name:ONE LOVE PERIODIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-537-9551
Mailing Address - Street 1:201 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4095
Mailing Address - Country:US
Mailing Address - Phone:704-867-5254
Mailing Address - Fax:704-867-5276
Practice Address - Street 1:201 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4095
Practice Address - Country:US
Practice Address - Phone:704-867-5254
Practice Address - Fax:704-867-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8703220Medicaid
NC6008242Medicaid
NC6603804Medicaid
NC8301457VMedicaid
NC5916270Medicaid
NC3410218Medicaid
NC8301457HMedicaid