Healthcare Provider Details

I. General information

NPI: 1053088658
Provider Name (Legal Business Name): ONE LIFE ONE LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 SCOTT ST
BALTIMORE MD
21230-2528
US

IV. Provider business mailing address

1139 SCOTT ST
BALTIMORE MD
21230-2528
US

V. Phone/Fax

Practice location:
  • Phone: 443-226-6266
  • Fax:
Mailing address:
  • Phone: 443-226-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES FREDERICK JOHNSON JR.
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW-C
Phone: 443-226-6266