Provider Demographics
NPI:1396892055
Name:LOVE, PAMALA TATOYA (PHDC, LCSW, TF-CBT)
Entity type:Individual
Prefix:MS
First Name:PAMALA
Middle Name:TATOYA
Last Name:LOVE
Suffix:
Gender:F
Credentials:PHDC, LCSW, TF-CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9526 ARGYLE FOREST BLVD
Mailing Address - Street 2:STE B2, #602
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222
Mailing Address - Country:US
Mailing Address - Phone:910-248-9359
Mailing Address - Fax:980-338-8519
Practice Address - Street 1:1201 FORESTDALE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:910-541-9114
Practice Address - Fax:336-447-6112
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0062951041C0700X
NCC0060401041C0700X
FLSW210821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC006040OtherNC SOCIAL WORK CERTIFICATION AND LICENSURE BOARD
FLSW21082OtherBOARD OF CLINICAL SOCIAL WORK, MARRIAGE & FAMILY THERAPY AND MENTAL HEALTH COUNS
GACSW006295OtherBOARD OF PROFESSIONAL COUNSELORS, SOCIAL WORKERS, AND MARRIAGE & FAMILY THERAPIS