Provider Demographics
NPI:1346648193
Name:LOVE, LATRICE LASHAE (LPC)
Entity Type:Individual
Prefix:
First Name:LATRICE
Middle Name:LASHAE
Last Name:LOVE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 DIAL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-2003
Mailing Address - Country:US
Mailing Address - Phone:803-331-7767
Mailing Address - Fax:866-736-0574
Practice Address - Street 1:136 FORUM DR # 108
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7942
Practice Address - Country:US
Practice Address - Phone:803-251-9465
Practice Address - Fax:866-736-0574
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11317101YM0800X
SC6051101YM0800X, 101YP2500X
SC5754101YM0800X
CO0015984101YP2500X
VA0701010289101YP2500X
GA009331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1506Medicaid