Provider Demographics
NPI:1659930782
Name:LOVE, MICHAEL M (PSYD, LCP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:LOVE
Suffix:
Gender:M
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5744
Mailing Address - Country:US
Mailing Address - Phone:540-557-7629
Mailing Address - Fax:
Practice Address - Street 1:102 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5744
Practice Address - Country:US
Practice Address - Phone:540-557-7629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005538103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling