Healthcare Provider Details

I. General information

NPI: 1245146281
Provider Name (Legal Business Name): SP COMMUNITY SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12126 LEMMOND FARM DR APT 3511
CHARLOTTE NC
28227-8308
US

IV. Provider business mailing address

12126 LEMMOND FARM DR APT 3511
CHARLOTTE NC
28227-8308
US

V. Phone/Fax

Practice location:
  • Phone: 980-384-1587
  • Fax:
Mailing address:
  • Phone: 980-384-1587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHI'VONNA TI'QUEL PATTERSON
Title or Position: OWNER
Credential: QP
Phone: 980-384-1587