Provider Demographics
NPI:1023131752
Name:LOVE-WINTER, WILLIE JEAN (MSSW, LICSW, LMFT)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:JEAN
Last Name:LOVE-WINTER
Suffix:
Gender:F
Credentials:MSSW, LICSW, LMFT
Other - Prefix:
Other - First Name:WILLIE
Other - Middle Name:J
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW, MSSW
Mailing Address - Street 1:6136 KALEN CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-9577
Mailing Address - Country:US
Mailing Address - Phone:651-459-0443
Mailing Address - Fax:651-459-4510
Practice Address - Street 1:6136 KALEN CT
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9577
Practice Address - Country:US
Practice Address - Phone:651-459-0443
Practice Address - Fax:651-459-4510
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLICSW #53481041C0700X
MNLMFT # 0602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6G134WIOtherBLUE CROSS BLUE SHIELD
MN281333OtherVALUE OPTIONS