Provider Demographics
NPI:1174876106
Name:LOVE, DEBRA LASHLEY
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LASHLEY
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2129
Mailing Address - Country:US
Mailing Address - Phone:706-718-2766
Mailing Address - Fax:
Practice Address - Street 1:7712 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2129
Practice Address - Country:US
Practice Address - Phone:706-718-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health