1063286649 NPI number — LOVES LEGACY COUNSELING PLLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063286649 NPI number — LOVES LEGACY COUNSELING PLLC

Employer Identification Number (EIN):

Provider Organization Name:

LOVES LEGACY COUNSELING PLLC

Provider Last Name:

Provider First Name:

Provider Middle Name:

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Provider Other Last Name Type Code:

NPI Number:

1063286649

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

04/10/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

717 GREEN VALLEY RD SUITE 200 UNIT 242 GREENSBORO, NC 2

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GREENSBORO

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

27408

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

5540 CENTERVIEW DR.

Provider Second Line Business Practice Location Address:

SUITE 200 OFC 723

Provider Business Practice Location Address City Name:

RALEIGH

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

27606

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

336-860-4525

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

11/14/2023

Authorized Official Last Name:

MCDANIEL

Authorized Official First Name:

BRIA

Authorized Official Middle Name:

Authorized Official Title or Position:

OWNER

Authorized Official Telephone Number:

336-709-5251

• Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103TF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103TP2701X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103TS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .