Healthcare Provider Details

I. General information

NPI: 1396536488
Provider Name (Legal Business Name): LOTS LORD OF THE STREETS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 STEWART SPRING LN
CHARLOTTE NC
28216-2170
US

IV. Provider business mailing address

9910 STEWART SPRING LN
CHARLOTTE NC
28216-2170
US

V. Phone/Fax

Practice location:
  • Phone: 704-200-4150
  • Fax:
Mailing address:
  • Phone: 704-200-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. DOROTHY LOUISE ALEXANDER CLARK
Title or Position: PRESIDENT - CEO
Credential: EDD
Phone: 704-200-4150