Provider Demographics
NPI:1427115005
Name:LOVE, SAM (LPC)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:LOVE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W JACKSON ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-6100
Mailing Address - Country:US
Mailing Address - Phone:478-275-1125
Mailing Address - Fax:478-275-7512
Practice Address - Street 1:212 W JACKSON ST
Practice Address - Street 2:SUITE F
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6100
Practice Address - Country:US
Practice Address - Phone:478-275-1125
Practice Address - Fax:478-275-7512
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional