Healthcare Provider Details

I. General information

NPI: 1265336655
Provider Name (Legal Business Name): THE LOGOS COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 MERLANE DR
CHARLOTTE NC
28206-1355
US

IV. Provider business mailing address

4115 MERLANE DR
CHARLOTTE NC
28206-1355
US

V. Phone/Fax

Practice location:
  • Phone: 818-595-9558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GLORY SANDERS
Title or Position: PRESIDENT
Credential: PHD
Phone: 828-595-9558